Jennifer wrote:

<There is also the complex reality that the mom is often 5
days or more into breastfeedsing when she sees me and now we have
supply probelms, weight gain concerns, supplements to deal with and so
on--when the whole problem originated in an inefficient latch.>

In addition, it's also important to know whether the mom (like such a very
large % do) received multiple bags of IV fluid and/or pitocin induction and
to ask other questions such as "are your ankles or fingers swollen?" in
order to factor in the great probability that by day 5, edema, in advance
of, or superimposed on normal engorgement may well be causing significant
problems with incorrect latch in and of itself.

IME, the contour of the breast and the pliability of the nipple-areolar
complex that was seen and pronounced to have a baby "well-latched on to it"
in the hospital is a more often than not, a significantly far cry from the
contour of the breast and the pliability of the areola of the same breast on
day 5 (and 6,7,and even 8 or more/!)

In addition to all the other things that must be considered in assessing a
latch, above all, I believe the areola absolutely must first be pliable
enough to elongate during the latching process to extend the nipple itself
toward the soft palate and allow the tongue to reach the subareolar ducts.
All the other frequently suggested approaches to positioning the baby will
then work much more effectively.

Jean
*****************
K. Jean Cotterman RNC IBCLC
Dayton, OH USA

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