Boy, I was really struck by your clarification.  I could not agree more that
the issue of competence is central.  There is a danger of over-involvement,
and of wanting to have breastfeeding succeed perhaps more than the mother.
 It is very healthy and certainly implies a delicate sensibility that the
nurses can stand back and let the mothers learn on their own.  This issue of
competence carries over into your remarks about the adopted babies
experincing a kind of re-birthing (crawling to the breast of the adopted
mother and latching.)  I see a fair amount of adoptive mothers and I intend
to try this.  But back to the latch on with the very shell-shocked,
traumatized mothers. There must be a mid-point between doing too little and
too much.  When I say I do hands-on, it means that I try to help get the baby
in the right plain, slightly behind the nipple, with a bit of suggestion of
postural support.  I show mother how to lift her breast if needed, but then I
suggest she wait and let the baby 'find it.'  Its so beautiful when the
mother sees how much skill the baby has -- so much delighted laughter.  I
often see mothers 'chase' the baby with the breast, or make 'nipple
sandwiches' and try to squish the nipple and poke it into the baby.  Helping
them see that is unnecessary and way too much work can free them up to relax
a bit.  But your point is very well taken.
I enjoy hearing your ideas.
Barbara Wilson-Clay, BSE, IBCLC Austin, Tx