Diane - Bravo!  Your close observation about what happens as a baby roots,
takes the breast into his mouth and starts to suck is so helpful.  Having
worked with many many older babies who have previously been fed only by
bottle for several days or even weeks, and then seen how they can achieve a
latch and breastfeed perfectly when the positioning/latching techniques are
made really easy for them I share your scepticism about nipple confusion.
Simply blaming the bottle for a latching difficulty is to stop looking for
other causes.

I am lucky enough to do private consults in a couple of hospitals, so I see
a *lot* of babies from Day 1 - 3. *Most* of these moms want to see an LC
because the baby is not latching and by far the most common reason is that
the baby's 'S' spot is not being stimulated.  Either the nipple is too
short, or the mother's technique is such that she doesn't bring the baby's
mouth far enough on to the breast.  There are no bottles in our hospitals,
yet the babies are behaving exactly as if they are "nipple-confused", which,
in fact, they are.

I think the confusion is partly due to our terminology.  In the US the word
"nipple" refers both to the teat on a bottle, *and* the nipple on a breast,
am I right?  And "nipple-confusion" is usually used to describe the
occasional arching, crying, terrier-like head-shaking behaviour of the baby
who has previously been fed with a bottle*-nipple (teat) upon being offered
the breast. My observation is that the baby is more likely to be
demonstrating confusion and frustration because he simply can't feel the
*breast*-nipple on his 'S' spot.  This is indeed nipple-confusion -
confusion about the *real* nipple. Provide stimulation to the junction of
his hard and soft palates (whether it's an upturned finger, a bottle-teat, a
nipple shield, or a strategically stretched-and-placed real-live nipple) and
he will close his mouth around the object and "latch" easily.  The bottle is
*not* the problem and can sometimes be a useful tool to "teach" a baby how
to suck.  We need to stop blaming the bottle and start paying closer
attention to the breast/nipple shape and the mother's latching technique.

Incidentally, Anna, I think the WHO (and my Ministry of Health) concern
about bottles and teats relates to their ability to harbour bacteria and the
difficulty that women in poor environments with no running water would have
in washing, cleaning and sterilizing them.  In any situation where babies
are not breastfed direct then *cup-feeding* is heavily promoted because cups
have no nooks and crannies, are easy to keep clean and don't need to be
sterilized.

Pamela Morrison IBCLC, Zimbabwe
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