We have both kinds at my office... 

My co-worker is a La Leche League Leader who has become an IBCLC and sees
moms at home, in meetings and in our office.  She is much more comfortable
helping a mom by talking her through the attachment process and keeping her
hands off.  

We have discussed this, as some of the nurses in the hospital feel this
reflects her lack of experience - which is not so, as she has been helping
many moms who came to her house long before she was an IBCLC because there
was no one to go to.  

When I was an LLLL the moms who came to see me were convinced they wanted
to bf and those who weren't had quit - didn't even make it to my meetings
or certainly not to come to my house for help.  As a nurse in the hospital,
I see lots of moms who are so-so about breastfeeding and have a "show me" 
attitude.  For this reason I have developed a much more "hands on"
approach.  Often moms don't even believe baby will latch on, and it's only
after seeing that it does happen that they "fall in love" with the idea.

So - I do watch to see what mom is doing - and if she comes from outside to
see me I ask her to show me without touching at first - but if nipples are
terribly traumatized or if mom has been unable to latch baby on well before
coming, chances are she won't do much better even with my "cueing" her
because she has developed habits (cigarette hold, stomach of baby up,
leaning towards the baby, etc ) which are hard to cure all at once without
sounding like a drill sargeant "Sit up, Put baby on her side, hold your
breast this way...etc" 

So in MOST of my cases I put on gloves so I can put a finger in FAST in
case it hurts, and help mom position herself and her baby comfortanbly then
I show her where to put her hands to support baby's back and hold her
breast (I usually use football or modified madonna hold when teaching).  I
then guide her and get baby to latch on as comfortably as possible (often
with no pain, which makes mom relax and NOW she's willing to learn from me
what we did to make it work).

I know there are experts who feel we should NEVER touch a baby - but I am
one of those people who was "all thumbs" with her baby as I am "all thumbs"
with most of manual dexterity abilities.  For example, I couldn't make
bread - even following a cookbook - until I watched my mother-in-law do it
and she showed me how the kneaded bread should feel.  I could not drive a
stick shift until I was shown, with a hand on mine, what the stick was
supposed to feel like.  Some people are oral learners, others visual,
others kinesthetic, and women, if we follow the "Women's Ways of Learning" 
book are even more in need of kinesthetic experiences.  

My answer to this question is as in most cases - follow your own gut
instincts.  First of all, if you are comfortable with what you are doing,
and it works for you, don't change.  Moms can sense if you are
uncomfortable and that would not be helpful.  However, if you have tried
one way and it doesn't seem to work well with a particular mom, try another
and see if this works.  Flexiblilty is one of the signs of the experienced
teacher - having more than one way to teach a subject.

Jeanette Panchula, BSW, RN, IBCLC
Puerto Rico
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