Nikki says: "Nothing on nipples at the beginning, please."

I couldn't agree more - however, the other part of her statement:

" What is going on with the clinical situation that a newborn would have to
thus enticed to do what all its reflexes are programming it to do?"

...brings up even more of what is frustrating us all...that there are SO
MANY things that are "going on" with the clinical situation that is WRONG
that we can't address for THIS mother and baby!

As much as I work to change the hospital policies and procedures in
California (see http://www.mch.dhs.ca.gov/programs/bfp/toolkit/default.htm),
when I see a mom and baby, I have to deal with what IS, not with what I
would like it to be.

Skin to skin and "nothing on the nipple" is the FIRST step whenever we see
moms and babies.  However, I have to deal with babies that have been exposed
to medications during delivery, separation, pacifiers (pain control for
circumcisions...don't get me started on THAT one), early discharge, getting
home with family who make impossible demands, stairs to climb and
unbelievable life situations.

If I don't get things started NOW - they will not keep trying.  However, if
I get things going (as I did on Thursday with a mom who was FURIOUS when I
called, feeling everyone and everything had let her down including a baby
who would not latch, and barely let me come visit her)...THEN we have the
opportunity to improve things, change viewpoints, model supportive behavior
and offer an alternative that may actually be what she really wants - once
she gets to feel a baby suckling at her breast.  I can't tell you the number
of times I've seen just ONE positive breastfeeding experience has changed a
mom! (and yes, there have been times when even THAT isn't enough and she
quits...)

Sooo Skin to skin and "nothing on the nipple" is the FIRST step - but we
need to have in our "bag of tricks" as many tools as possible.  Every time I
go to a conference or read Lactnet I learn another one - for this I thank
you all.

For those who are new IBCLCs PLEASE don't forget to START with Skin to skin
and Nothing on the Nipple - and time needs to be allowed for both!  However,
the more you learn, the more options you have to help more and more mothers
with different situations.

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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