Hello.  I am an LLL Leader needing some opinions.  I realize I am supposed
to check my LLL sources first, but this is one of those situations where it
would be helpful to hear from more than one person.  I do a lot of reading
and I have a number of the recommended books.

The nurse midwife called and asked me if I could help a mother in the
hospital.  This is the first time I have been asked to go to the hospital
so it is exciting for me.  The baby didn't nurse well after birth even
though he was alert.  The delivery was uncomplicated with no medications.
I saw the mother that next evening and the baby was in the sleepy phase and
wasn't interested in nursing, although he did get in one or two good
nursing sessions before this time.  The nurse did try a nipple shield a
couple of times, which I know is not always recommended.  While I was there
we could wake the baby, but he was not interested in latching on.  He was
content to go back to sleep.  My gut feeling was that he didn't need to
nurse at the time and would soon "wake" up and want to nurse.  Luckily, the
nurses did not feel that supplementation was necessary.  I talked to the
mother about positioning and keeping the nursing sessions calm so that the
baby wouldn't associate breastfeeding with something bad.  He had two bowel
movements and a wet diaper so he was doing good in that area.

Anyway,  I went back in the morning and sure enough the baby was showing
more interest and had several good nursing sessions.  I wanted to check to
make sure his lips and tongue were in the right place.  Everything looked
good but it made him come off.  The mother tried to get him back on but he
wouldn't latch.  He would open his mouth but he acted like he didn't know
what to do with the breast once it was in his mouth.  The mother's nipples
are not flat, but they don't really stick out far.  It almost seemed like
he would get his mouth on the breast but he wasn't stimulated to suck.  I
know he can suck because I saw him when I first came in.  Does the breast
tissue have to touch a certain part of the mouth to stimulate sucking?  I
had the mother try the nipple sandwich and it seemed to help a little but
he still would not suck.  The baby became a little frustrated, but the
mother was doing great (and I told her so).  I probably didn't need to make
this so long, but this is a common scenario and I want to learn all I can.
Here's the part where I need your opinions.

The nurse came in and decided that the baby needed to get on the breast
since we had tried for about 30 minutes.  She took the baby's head in one
hand and the mother's breast in her other hand and basically smooshed the
breast into the baby's mouth.  She was pretty gentle.  Anyway in less than
15 seconds she had the baby nursing!  I felt humbled!  This is common
practice for most nurses at this hospital.  Some are more gentle than
others.  I was trying to have the mother do all of the "work" while I
verbally guided her and helped with positioning.  Should I have been more
hands on?  In all of my books there is no description of how the helper can
physically grasp the baby's head and the mother's breast to get the baby
latched on.  The nurse did not wait for the baby to open wide she just put
him on the breast and pushed (gently) the breast tissue into his mouth just
as you would push clothes into and over-stuffed drawer.  The baby was not
distressed and I am sure the mother was relieved to have him nursing.  The
nurse did not check to see where his tongue or lips were.  If mom is not
sore do you still need to check these things before mom goes home?  Also,
if this is the way the baby needs to be latched on how will the mother do
it on her own when she gets home?

Afterwards, I told the nurse that I have a lot of book knowledge about
breastfeeding, but I do not have a lot of hands on experience.  I asked if
I could come in as a "student" to watch babies nurse and practice more
hands-on techniques.  She got excited about the prospect of having me come
in and putting all of my experience with theirs to really help mothers to
breastfeed.  She ran off to talk to some other nurses about it and they
were excited too.  I also told her that I am eligible to sit for the IBLCE
exam and I am back in school to become a nurse so I really want to learn
all I can.  They are trying to revise their budget to bring on an LC.

I don't mean to write a book here, but I have so many questions about
breastfeeding, but not many people to "talk" to.  I live in a small town
with no breastfeeding professionals.  Don't get me wrong, LLL is the first
place I go when I need information or advice.  I really enjoy Lactnet
because of the diversity of people from all over.  There is a huge amount
of breastfeeding experience on Lactnet.  I wish LLL had something similar
for Leader's, but I have not heard of anything.  Thank you so much for your
time.  :-)
Christine Lichte,  LLL Leader

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