That was the subject of the very first inservice I was able to convince a
hospital to allow me to do when I moved here!  I collaborated with their
ergonomist.

It was a "hands on" training in a patient room, so I don't have a
Powerpoint presentation on the subject but what I covered was:

Remove clothing from baby and put baby skin to skin ASAP after your shift
starts and the mom is comfortable (has gone to the bathroom, eaten,
etc)...this will often simplify your life, as when you return you'll find
about 50% of the babies have already latched on, so you don't have so much
to do.

Raise beds - make sure mom is at your waist level when she's in bed. (But
don't forget to lower it when you leave.)

Use folded towels and blankets - they are more supportive and don't give as
much when trying to position mom and baby.

If mom has been unable to get the baby latched, use football hold as this
way your back is straight and you're not leaning over the mom (OUCH)...and
moms can see their baby's mouth and get the latch on better.

NEVER push the baby onto mom by pushing the back of the head - use her hand
to support the back and neck of the baby - you support her hand, so you can
remove yours when things are going well...rather than having to stay there
holding baby and/or breast - SHE has to be able to breastfeed, not have YOU
breastfeed her baby with her breast!

If mom is in a chair - either sit next to or in front of her  - or kneel in
front - either way, your back is straight.  If you lean over her, you may
not be able to straighten up! (That happened to me a few times and I
learned to do better - I'd rather have sore knees - I usually use a folded
towel to kneel on!  I remember one dad seeing me commented that I was "on
my knees" and I commented yes, and I'm PRAYING TOO - they were TWINS with
tongue-tie! <GRIN>)

Give mom pointers and ideas for 5 - 10 minutes - then LEAVE - your standing
over her or leaning over her and stressing her and the baby usually does
not help with latch - give her opportunities to try different things on her
own, then come back, and see how the baby is behaving - show her the baby's
signs that he's ready to try latching again.

Lots of frequent assistance is less intimidating than a nurse who's working
up a sweat (and the mom's) trying to get a baby latch who is too sleepy or
frustrated.

Include family members so they learn how to help the mom - she's going home
in 24 - 48 hours and will need their help/buy-in.

Know community resources when mom is discharged who is still having
problems breastfeeding.

(At the same time as I was teaching "ergonomics" I was also teaching skin
to skin, frequent small meals, cue feeding, and collaboration - and they
didn't even know it!)

Jeanette Panchula, BSW, RN, PHN, IBCLC
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