April,

This is one of the first things I have been telling moms who have a problem that suggests the baby is protecting his/her airway:

When baby is starting to wake up, prior to hunger signals, suggest that she lie down halfway or more, even to lying almost flat with 1-2 pillows, with baby's head between breasts to hear her heartbeat, (a la Suzanne Colson's research) and let baby wake and search for or help him search for the breast. A newborn's head is quite heavy, and difficult for him to lift in this position, so whatever latching he does, it will stay deeper and more consistent. In addition, the milk will be coming upward to him like a drinking fountain, not downward, like being under Niagara Falls! (This way, the actual force of the uphill MER will be slowed/lessened by gravity as well.) When he gets used to this, he will soon give up the "protection" reaction when he finds he can freely use his swallowing reflex, without the fear-of-choking sensation he may have associated with rapid milk flow. This is especially helpful if the mother's breast is the least bit pendulous - even a C cup or beyond, because of the "downhill", gravitational force on the speed/path of the MER on the milk when she is sitting up with weight of the breasts tilted downward.


An alternate position can also be tried with both mom and baby lying on their sides facing one another, where they are on an equal gravitational level. The force of gravity on the milk, no matter how fast or powerful the MER, is more likely to be "attracting" the milk toward the side next to the bed surface, allowing spillage/leaking of any excess volume he can't "handle" to leak out that side of the baby's mouth, so he doesn't feel forced to choose to "retreat" back off toward the tip of the nipple or clamp down to stem the flow to avoid feeling like he might choke or drown! 


Also helpful might be triggering the MER with the fingertips by hand (works fastest with either RPS or some fingertip expression), waiting 2 minutes or so when the greatest force has passed, then letting him latch, in any position she wants. I just read today that additional MER's during a feeding are usually less forceful than the first MER in a feeding.


Hope this helps. 


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

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