>      Did any study ever assess latch-on and positioning prior to giving any
> product?

Actually, during my conversation with Kate Chalmers about the Dodd and Chalmers JOGNN
study, Kate told me that her original study design had a third arm consisting of mothers
who only received instruction in latch-on and positioning and received no products (in the
final study the two groups of mothers receiving products both received this instruction).
But when they presented this original study design to their hospitals' Internal Review
Boards, it was rejected by both because it was considered unethical to withhold treatment
that could alleviate nipple pain, thereby putting breastfeeding at risk.

In answer to your question, though, there is a new study  that just appeared in
Breastfeeding Review (one of my favorite breastfeeding journals--kudos to my new Aussie
friends!).

Blair, A. et al.  The relationship between positioning, the breastfeeding dynamic, the
latching process and pain in breastfeeding mothers with sore nipples.  Breastfeed Rev 2003;
11(2):5-10.

In this study, the researchers looked at many aspects of positioning and latch-on to see
which factors might affect the mothers' comfort levels.  A pain scale of 1-5 was used (1
being no pain, just tugging and 5 being very severe pain)  The 95 mothers were included in
the study when they reported sore nipples within ten days of birth. The pain scores broke
down as follows:  0% rated their pain as 1, 9% as 2, 46% as 3 (moderate pain), 26% as 4 and
12% as 5.  After analyzing many factors, the researchers concluded that there was no
association between the level of pain reported and the baby's head position, body position,
or breastfeeding dynamics of the baby.  However, improving the latching process was
slightly related to lower levels of reported pain

I was excited to see this study, because as I've said in some of my recent talks, it is
interesting to me that up until this study was published, there has been no research on the
single most critical aspect of successful breastfeeding--achieving a good latch.  We like
to talk about being an evidence-based profession, but we have a long way to go before we
have any convincing evidence on this most basic aspect of breastfeeding.

Those of us who are experienced in the field know how important this is, but as Magda so
accurately pointed out, technique is everything, and this is not something that can be
learned from textbooks.  Up until now, these kinesthetic skills have been passed down from
one of us to the other or puzzled out in the heat of the moment.  IMHO, figuring out
effective strategies for how to pass along this knowledge to others is one of the biggest
challenges our field faces.

Congratulations to the researchers for their efforts to increase our knowledge in this
critical area!

Nancy Mohrbacher, IBCLC
Chicago suburbs, Illinois USA

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