Bonnie,

This mother's dedication to establishing breastfeeding seems nothing short of heroic, what with her pregnancy dreams having been so "rudely" interrupted, to say nothing of the baby having undergone the many efforts the staff made to help her baby's survival.


I am no expert in this aspect, but I have been reading a lot recently about oral invasion and the reaction of babies, so I hope someone more knowledgeable addresses this and how to overcome it.


Having said that, I will muse on some of my past experiences. My first thoughts would be to carefully observe the  speed of delivery of milk from both the bottle and the breast, if that much actual breastfeeding is going on. No matter what a label says about slow flow nipples, 2 packages of the identical brand and type can have differing hole sizes giving different flow rates. In addition the speed of liquid's passage from the bottle is influenced by the temperature of the milk inside - cold (not often done, I imagine), room temperature, or warmed up to body temperature, and alas, sometimes beyond.


After having fed many thousands of babies the bottle in all my years of hospital care and many of my own 6 children, and numerous grandchildren, I was amazed at the sensitivity I must have lacked and the distress I must have caused by my "approval", and even "satisfaction" of their "chugga-lugging" down so "efficiently". I have begun appreciating more and more the part that gravity plays in the movement of fluids (milk, and edema as well), and realizing how "clueless" I have been in virtually overlooking it, or perhaps almost ignoring it throughout decades of baby-feeding experience. 


When I began to read the various sets directions for "pacing" bottlefeeding, with nearly upright position of the baby and nearly horizontal position of the bottle, and inserting deliberate pauses, I began to realize that one of the main things it does is to remove much of the force of gravity from the speed of the milk flow. The baby does not have to undergo nor tensely anticipate the stress of any "near-choking" sensations, and also has the relaxation of pauses for "normalizing" the breathing pace, a wonderful lifelong eating habit and helpful in preventing obesity, BTW. I am not pleased with the instruction sheets I have seen, and I hope some speech therapist writes another better one than I have yet seen. 


I am now trying to help parents whom I call or I meet at WIC, understand that the baby has been free to suck and swallow as s/he wanted in utero, without the need to breathe. I try to do this especially for those who ever feed a bottle. I try to help them understand that now, breathing must take precedence among the several reflexes at work in the lower throat. While learning to coordinate breathing with sucking and swallowing, sometimes babies have to cope by seeming to swallow "for dear life" so they can avoid the awful sensation of choking or "drowning", or "being under Niagra Falls." (I'm trying to involve their imagination in the panic that babies might well be feeling, to emphasize the seriousness of the issue.) 


I try to explain to them how this differs from the way most folks today may remember about how to feed a bottle, from the experience of babysitting when we were teens, and how many experienced older relatives may need to understand this in order to change their feeding style without feeling insulted, especially to avoid "flow-rate" confusion and breast rejection.  I describe to them how this gives the baby freedom to choose when to suck, or not, how fast to suck and swallow, and when to pause in the sucking, and when to breathe, and I encourage them to watch how the baby still often uses the pauses to "recuperate" back to a relaxed breathing pace. I am pleased when I see a light bulb go on over their heads, and imagine this gives them a vivid way to explain it to family and daycare personnel. 


I think the same forces, perhaps stronger, can confront babies at the height of an MER, and I know LLL has long been giving mothers advice on ways to "remove gravity" or reduce the speed of the flow by explaining how to trigger the MER first, etc. so the baby has less need to cope with it. I find this is especially important when the mother's breast is anywhere near pendulous, and find this "removal of gravity from the force of the milk flow" one more valuable feature of "laid-back" position(s) for nursing, especially when great supply is present. 


Perhaps you have already considered all this. But there may be others who are looking for ways to help teach parents what to observe in their babies' feeding situations. So, FWIW, I decided to write about my reflections on this as a good place to begin. 


Very best wishes to this mom and baby, and you as well, and please relay my huge respect for all her efforts thus far.


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC     Dayton OH

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