I think that hands-off verses hands-on is entirely dependent on the
situation of the individual client.  Since I've been doing the Great Starts
program I have become even more hands-on than I used to be.  I do catch myself
telling the baby what I am doing more often then I tell mom.
     Babies are about 4 days old at Great Starts and the moms that are having
a problem (engorgement, latch on and sore nipples), need it fixed RIGHT NOW or
they will quit.  I have to quickly isolate and treat the immediate problem.
There isn't time for a full history or long explanations (Monday I saw 22
couplets in 3.5 hours).
     I have mom show me what she's doing.  If the problem is minor I make
suggestions and let her try on her own.  Normally they get it right on their
own after one or two tries.  However, I will NOT allow babies or moms to get
upset or distraught in the process.  Once that happens, its hands-on all the
way.
     When the nipples are really sore, cracked and bleeding I admit I am
GUILTY of take-over behavior.  Then I make whatever changes need to be made.
If I can get the baby latched on once without pain, to show mom it can be
done, the battle is won.  If I do happen to move the baby a little too
quickly, I apologize to the baby and explain to the mom the reason for the
Rapid Arm Movement (to bypass the clamp on the sore nipple).
     Then there's the ones where mom is the problem.  I am sure LC's have all
seen the moms that  are so obsessed with doing it right or suffer from such
performance anxiety, that nothing works.  I had a  baby the other day who
would not latch on.  Mom was tense,  all hunched over, gripping the baby so
hard and so tight that baby screamed in panic every time she held him.
Finally, out of desperation, I had her put her arms up on the chair while I
held the baby and the breast and latched him on.  He nursed beautifully.
After the pediatric nurse practitioner did her examination,  I looked back and
there sat mom and baby with a bottle in his mouth.  So much for showing her
that the baby could and would nurse.  I had hoped she will do better at home.
She was just as tense in my office the next day and still could not get the
baby to latch on.  Now multiple bottles are making the situation more and more
problematic... <sigh>
     My instruction sheet is very detailed.  They take it with them for
reference plus whatever other handouts are needed (pump rental stations,
cabbage, breastfeeding info booklet etc...)  Those that need follow-up are
scheduled for a full consultation in a day or two, depending on the severity
of the problem.
     Although this method of practice isn't the ideal way, it IS working.
Many mothers tell me later that they were ready to quit the day they saw me
and have kept nursing.  A little hands-on help at the right time goes a long
way.
Marie Davis, RN, IBCLC