Lactnet friends,

Remember as I post this, that my experience has only been with births in the USA or abroad at a US hospital.  And I don't presume to speak for all births in hospitals in the USA.  Only those I have been privileged to attend.  At the risk of sounding like an interfering nurse (I am a Labor and Delivery nurse for 23 years in the USA and American hospitals in Germany) I usually do the following.  No matter if the mom is C/section, natural, epidural, stadol etc, I usually offer to show the new couplet how to accomplish side lying nursing for their first session.  Although there are some couplets who say no when I offer, ( they can only imagine sitting up to nurse or in a rocking chair  because thats all they have seen up till now in books, TV) I let them know that in my experience, side lying initially provides many positive things:

1.  Less stress and potential for swelling on new mother's bottom after delivery.

2.  In side lying position the nurse is able to assess vaginal bleeding easily and less obtrusively during recovery period.  When a patient sits up to nurse after delivery the blood often will pool in the vagina and be unable to drain well thereby setting up risk of less clamp down of uterus while nursing.

3.  Less manipulation of the new infant.

4.  Infant is able to get most or all of the clear signals it needs to know to understand what process is about to happen.

5.  It gives the new family permission to try a new position and to open up discussion about the baby in the bed with her and getting rest for the first couple of weeks.  I talk to them about side lying curled around the baby  and while they are in the hospital placing a pillow jammed between the side rail and the mattress like a bumper pad.  I emphasize "jamming" the pillow so it doesn't fall on or behind the baby.


(If mom is C/S then this following hold is modified as noted below this paragraph)

Infant is unwrapped and placed on its side facing mother; mother lies on her side facing infant and bed is flat.  Only pillow is under mom's head and if she wants, then another between her knees and to her back.  Her body is in good alignment and infant has a blanket rolled up behind his shoulders and back.  My hand, dad's hand or mom's hand is on infant's back and under the babies neck and shoulders to help bring the baby to the nipple when it opens its mouth wide.  I never place my hand on the back of the babies head or tell the parents to do that.  I heard somewhere at a conference that this initiates the babies suffocation reflex and makes them push back against your hand thereby going the opposite direction that you are striving for.  I emphasize to parents never to place the roll behind infants head so the infant can freely move his head backward if needs to for repositioning for breathing etc.  Infant is placed nose to nipple and head tilted slightly back to achieve latch.
 Both baby hands are up by the breast.  One baby hand under the breast and the other baby hand on top.  Baby in this position is able to see the dark areolar area, able to see mom's eyes, sniff colostrum that is placed on nipple from mom's quick breast massage and while allowing infant to lay in this position for a few minutes while she gets ready to latch baby.  Notice the latch is the last thing to be done.  I usually see nurses, patients, family members etc try to achieve latch as the first thing and then get everything situated and they say the baby didn't want it etc because they didn't do more than lick or nose dive into the breast.  Probably we were interfering with the signals the mom's body and baby were trying to use to achieve a feed.

I try to tell mom's (and other nurses) that when we let the baby touch the breast, the babies eyes to see the dark areola, the nose to sniff colostrum the tongue to lick the drop and the baby to look at moms eyes, the sensations in the baby's mouth... then we are speaking to babies in their language many thousand years old.  The baby understands from all these "signals" that feeding is about to happen.  Very rarely do I have an infant that doesn't't know what we are doing at this point.   I like this because its very gentle to mom and baby, but also lets them "connect" as they should after delivery.  I show mom's and dad's to help the infant achieve an asymmetrical latch by tilting the babies head slightly backward and teasing with the nipple, then when the baby opens wide, aim the nipple to the roof of the babies mouth.  Then we look together at the babies latch and listen for swallows every 4-10 sucks.  I explain at this point that we are trying to transfer colostrum from mom to
 baby and so we watch for the swallows to assure that.



I think sometimes sitting up and the tension/exhaustion in her arms or subtle feelings of needing to hold the infant close to the new moms chest instead of down next to her breast can and do seem to interfere with holding the infant for the next 20+ minutes for feeding after delivery.  Even with a pillow under her elbow.  So the infant may "slide" down the nipple, or come higher than the nipple or get "bounced" while the new mom talks to visitors/nurse/family etc after delivery.  All of these can interfere with the "signals" the infant is taking in while trying to concentrate on his/her mouth and nursing.  And some moms can sit up to nurse from the beginning and do it well, but this I find is rare after about the 8-12 hour mark, they are just exhausted.


If mom is a new C/Section I offer to help her with side lying.  Often moms cannot sit up well immediately after a c/s the hour before because of blood pressure or epidural or spinal etc.  So this will greatly help her have a more positive first experience.  If she is a C/S then I pretty much know that I will have to do everything.  Most of the mom's I have had after a C/Section seem to think the first feed will not be at breast and are very hesitant about trying.  To those moms I tell them, "Give me the breast and I will do the rest" (kinda laugh.)  I elevate mom about 30 degrees and tilt her to one side.  I help her get the breast out and depending on the size of her breasts will try the modified football hold with the baby lying on pillows and essentially side lying with baby feet going the opposite direction than moms.  This seems to work well and dad's can learn to help in this position quickly.  All the other items mentioned at the beginning of my post are then performed now.
 Unwrapping infant, baby hands on breast, looking at dark areolar area, mom's eyes, massage breast and get colostrum to nipple for infant to sniff and taste etc.  Then I help to achieve asymmetrical latch with the same instructions of aiming the nipple to the roof of babies mouth.


Now I am not saying that this MUST be used for everyone.  Its just another tool.  I have found, however, that when I am called to the bedside to help someone breastfeed and they are 18 hours or 72 hours (whatever) post delivery, with the mother's permission, I might try this side lying first.  I find it helps me to speak to babies in their language of what it is we are trying to do.  With an exhausted family, less manipulation of the infant and their body, more signaling, then side lying helps especially when I am dealing with fussy baby behaviors learned from the first or second day.

I am sorry this is so long, but its hard to explain without really showing someone.  And for those who aren't in the hospital setting, then hopefully it gives you a little glimpse into an immediate postpartum period in a facility.

Theresa Johnson  RNC IBCLC
Orlando Florida USA



Patricia Gima <[log in to unmask]> wrote:
I have thoroughly enjoyed the thread about holds and latch. We are all
eager to discover what position and body action will assist the next
client/patient to feed her baby successfully.

I have wondered for a long time about our having mothers sit up, using the
"technique of the year" to feed their babies. I wonder if a mother's
sitting up and using her arms and hands as manipulators to a effective
latch is part of the problem. In less technologically oriented cultures it
seems as if Mother is lying on her side and her newborn latches with few
contortions on her part.

Are we wed to the sitting position for mother because of the generations of
bottle-feeding or are we forced to this position because of drugged babies
and lack of oxytocin response in mothers whose spinal columns were filled
with foreign substances during birth?

I know that in time a mother will want to sit to feed her baby but that may
not be an optimal beginning position when she is tired from laboring and
desires rest.

Do any of you encourage side lying from the beginning? Are your mothers
successful in this more natural position?

I find that tension in a new mother's arms is an added stress to her and
her baby. Mother is having to learn something totally new to her (when she
is tired from laboring and likely has a sore perineum) and everyone tells
her something different that *must* be done to get it "right." A baby lying
on a bed will be supported by a bed that is not fearful and tense and
desirous of achieving.

I would like to read replies from those of you who work with mothers who
deliver without drugs.

Pat Gima, IBCLC (Private Practice)
Milwaukee, Wisconsin
Mailto:[log in to unmask]





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