I had a "preview" with a couple in early January. They were having a home
birth with hospital back-up. Mom had had two terrible experiences with
breastfeeding and wanted to DO it this time. If the home birth didn't work
out she wanted to leave the hospital with a breastfeeding baby and no pain.

She fed her first baby for 4 months, crying and grinding her teeth the
whole time. She stopped because she found it hard to even look at her baby.

Next time she began again and the same sore nipples insued. She fed for 2
weeks and thought that she would rather look at and enjoy her baby, so she
stopped.

She was told that her problem was that she had large nipples that babies
couldn't accommodate. Her nipples had not shrunk since the last baby but
she wanted to give it another try. ( I certainly didn't fault her for
saying "try.")

[Lactnet lesson #1]
I looked at her nipples and assured her that I had seen much larger nipples
which babies could successfully draw into their mouths, feeding with
comfort to the mother and intake for the baby. She was encouraged.

She wanted me to be at the first feeding after the birth. I wasn't, but she
called me later in the day. She was cautious but had found that her baby's
feedings right after the birth did not hurt at all. Baby fed well and often
and was satisfied.

Lactnet lesson #2
What I saw when I arrived was not a "perfect" latch, but I didn't suggest
that she change anything. Baby and mom were happy.

Lactnet lesson #3 & 4
On day 2 she called with engorgement and baby was having trouble latching.
I was able to describe over the phone reverse pressure softening ala Jean
Cotterman. I also gave a "prescription" for cabbage leaves ala Jan Barger
(I think that hers was the first post in which I read about cabbage leaves.)

Mom called back several hours later-- exhuberant. The cabbage leaves worked
wonders for the hard breasts and the RPS did it for the edemic areola. Baby
had her latchable breasts back.

Lactnet lesson #5
Today (day 4) she called to say that one nipple was very painful and had an
angle after feeding, and the other one was beginning to be sore. I went to
see her and she was cringing at the thought of putting the baby on the very
sore side. Baby's suck on my finger was great. I demonstrated the
asymetrical latch (I'm not sure who observed and first shared that with us
on Lactnet. Was it Diane with her hamburger? Jack Newman? Or someone else?)
 and explained why it would be more effective and more comfortable. She was
able to get the baby to latch well and a big grin came over her face. "This
doesn't hurt!" [My favorite words in lactation.]

So I want to thank Lactnetters for all of your sharing of experiences and
observations in your work. These five lessons served me well this week with
this mother and baby. There are many, many other Lactnet lessons but as I
drove away from that home I was able to point these out to myself:

1) Babies can feed well on some of the strangest nipples. Nipple size and
mouth size does not have to create problems. An unmedicated baby who had
had nothing in her mouth will deal with what is there.

2) A latch doesn't have to be text-book perfect in order to be effective
and pain-free. "If it ain't broke, don't fix it."

3) Jean's reverse pressure softening lesson enabled me to give assistance
over the phone and it worked well. Of course, I was demonstrating at my desk.

4) Jan's cabbage leaves came through again, as they always do (with my
clients).

5) Asymetrical latch (whoever suggested it) gave baby a mouthful of breast
tissue and left mom's nipple as a lovely conduit for the delicious milk.

With much appreciation to the List Mamas and to all of you who share what
you see and know.

Pat Gima, IBCLC
Milwaukee, Wisconsin


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