> I find myself using more circumstantial evidence like #
> and quantity of poops, baby's behavior, mom's nipple comfort level, etc.
> for
> assessment. Does anybody else have this problem?

It takes more time and skill to evaluate and correct the "in-between latch"
(a latch between a really poor latch and a great nutritive latch with lots of
swallows).  I would say the largest majority of latches I see are the
"in-between latch."  Much more observance is needed and a great deal more
time.  Watching for swallows, looking at mom's nipple when it comes out of
baby's mouth to see the shape of the nipple, and assessing the baby's
behavior at the end of the feeding. I do test weights on all my assessments.
This is a valuable tool.  I most often know what I'm going to see when I put
the baby on the scale, but it validates my assessment.  There is more to
assess then just if the latch looks good.  Does the baby have a good latch
and nursing skills or does the mother just has a delay in milk coming in or
low supply?  It takes time to evaluate a nursing session and much more skill
then just "eye balling" a baby latched to a breast and saying it looks good
and walking away.  I spend at least one hour with newborns and families on
first assessment.  I do a great deal of teaching while observing and
gathering information.  Most hcps are not trained or geared to taking this
much time in an assessment, most don't have this much time to take.  We need
more LCs and to recognize that new mothers need someone to sit with her and
take this much important time to teach and fine tune her skills to instill
confidence in her ability to grow in her skills with as much hands off as
possible.  Confidence is not built in the mother by a nurse latching the baby
for her and walking away, it's built by teaching and encouraging.

The best answer I know to hospitals or pediatric sittings to help support
breastfeeding is to have LCs on staff and recongize that it's going to take
45-60 minutes for each assessment and maybe more than one session to really
empower mothers with the confidence and knowledge they need to have a more
successful breastfeeding experience.  HCPs need to be trained to look for
signs of early problems with the breastfeeding which includes a mother's lack
of confidence or anxiety level and to promptly refer to a skilled LC.

If we are going to walk the talk and promote how great breastmilk is for
mother/baby, we need to also offer her the support and skills to do the job
of breastfeeding her baby.  I often tell these heart broken mothers that come
to me after their breastfeeding problems have snowballed and they feel like
failures (wonderful way to start off motherhood, NOT) that our society has
failed them as a mother, they are not the failures, they are the victims.

I think the best thing a hcp can be taught is refer, refer, refer to a LC who
does have the skill to assess and spend the much needed time to evaluate and
manage the mother/baby's feeding skills.

Warm regards,
Pat Lindsey, IBCLC - Lactation Services  www.PatLC.com
Pediatrics Plus' Staff Lactation Consultant   www.pedsplus.com
Orlando, FL
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