Tricia, 

I agree with you...in terms of mothers in the hospital with a newborn.  They need time to figure it out (as long, as you stated, there is no serious pain), and there are many very strange positions I have seen in my 43 years as a La Leche League Leader (and still active) and 33 years as an IBCLC.  

However, once they are home, it may evolve that the baby may have an awful latch...yet not cause pain in the mother.  Baby may even be gaining weight because mom has been breastfeeding 45 minutes of every hour (losing weight in the process), or mom has been pumping after feeding and she then can compress breasts enough to get the baby to take the milk from the overfull breast, or mom is supplementing after feedings...(all information shared with me during La Leche League meetings).

As I often say when speaking to audiences of either hospital-based IBCLCs and nurses or home visiting/after discharge staff of Public Health Nurses and La Leche League Leaders, etc.  We need to understand that we see totally different mothers and babies!  The newly delivered mom and baby often don't even look like the same people a few days after delivery!  We have to also understand that what a mom tells us happened or didn't happen, is her perception...so we should try not to affix "blame", but rather work forward.  

An experienced breastfeeding mom with her 4th baby can still have unexpectedly complicated latch issues due to anatomical or movement issues.

A new mom may have not dared ...or in the US, had the time to communicate, or even know, if she was having pain as she is rushed from spot to spot in the hospital then discharged barely able to know how to change a diaper or remove a top, much less position herself and her baby comfortably.  (Yes, I made a home visit where it took the young couple 15 minutes to remove the clothing from their baby - and they appreciated my cheerleading, not taking over!) 

The problem often lies with the time staff has, to interact with moms and babies and observe them.  Hospital staff in our area are flitting from room to room with less than 10 minutes for each interaction.  Hardly time to ask questions, observe, provide options, and observe again whether these worked. Often the mom is discharged within 24 hours having seen 3 different shifts of staff!  Few times has the staff been able to give a positive comment to mom, something that we try to do at every interaction.  Instead they are trying to "put out fires" or at least do "damage control" as they see it.

 As a Leader, I can observe what is happening throughout the meeting, ask questions and listen, not only to the mother, but allow others to share their own stories...which often relaxes moms as they realize that this is a "learned behavior" and not blame herself for not doing it "right".     

As a Public Health Nurse/IBCLC I could take my time (of course, that often meant staying longer than my supervisor felt was necessary) and really see not only what is happening, but also give suggestions and have time to observe if they even worked!  

We do all worry about overwhelming moms...yet it is also important, especially during their short hospital stays, to let them know what we are observing...and that they should reach out early and to whom.  

Jeanette




Date:    Tue, 6 Nov 2018 15:55:45 +0000
From:    Tricia Shamblin <[log in to unmask]>
Subject: Incorrect breastfeeding technique and pain

 Thank you for bringing up this subject Kika.
I think this needs to be talked about more. I feel that there has been a shift over the past 10 years in this field to becoming overly technical and analyzing latch, position, suck pattern to the nth degree. It's a shame. People talk about "latching" now all the time instead feeding the baby. When there are problems or difficulties the mother is experiencing, it's important to observe and try to help. But I see a very disturbing trend now that we feel the need sometimes to go in and pick apart the mother's technique and it often reduces their confidence. Especially we should avoid this when no problems exist. I can think of 3 recent cases in which nurses told me the latch was too shallow and the mother's nipples were too long or wide to get a good latch. In each case they had successfully breastfed a previous baby for 1 to 2 years. The mother complained of no pain and the baby was fine. But latch looked a little shallow and the nipple was slightly creased, but no damage. In each case, the nurse had introduced the idea to the mother that the baby couldn't be getting enough milk with a latch like that. It took lots of reassurance from the LC's the parents were dissatisfied with the mixed message that they were receiving. I'm sure in these cases likely what is happening is that after mature milk production the infant will be sucking at a lower pressure and the milk flows faster reducing friction on the nipples. If the mother has nursed her last baby for 2 years, I don't really care what her positioning looks like unless she is complaining of pain or a problem, I generally leave them alone.
These guidelines about the benefits of latch and suck/swallow ratio are a good thing generally. But they can't be applied universally to every mother as a hard as fast rule. Every mother and baby are different. If there are not any existing problems - don't introduce any is my motto.
I heard someone say once that the definition of successful breastfeeding is - the baby gets enough milk and the mother doesn't have pain. Nothing else matters.
The tendency of many of the nurses I work with is to constantly analyze this on the first day and report to me that the baby has "an ineffective suck pattern." I usually respond with - it's 6 hours old. How about if we cut the baby some slack? Learning how to suck, swallow and breathe is the job of the newborn. They need to practice to learn. Taking them off the breast and syringe feeding them does not let them learn how to do this. If you never get on a bicycle you will never learn to ride it. I also find that among some, there is not an understanding that most of these rules about suck/swallow pattern (I think) really apply more to mature milk production and not as applicable during the colostrum phase. I try to remember that prior to 10 years ago, most of us knew nothing about the importance of a deep latch, versus shallow latch. And somehow most people managed to successfully nurse their babies. I'm sure my first daughter had a shallow latch because I had terrible nipple pain for 6 weeks and somehow she managed to gain 4 pounds in the first 6 weeks. I suspect that if I had her today in some hospitals I would have been counseled that she couldn't be getting enough milk and if we couldn't improve the latch, I should just take her off the breast and pump. Had I been the victim of that advice, there is no way I would have continued with breastfeeding. I do think given the choice, most mothers would rather muddle through a couple weeks of sore nipples, then be pumping and bottlefeeding around the clock. We need to avoid the message to these mothers that if the baby isn't latched on perfectly, or if they have any nipple pain at all, the baby can't be getting enough milk. Learning about improved latch is a good thing, but I think the pendulum has swung too far and some people are taking this to the extreme and it's becoming a detriment to some of the mother's ability to breastfeed. Tricia Shamblin, RN, IBCLC

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