Virginia, what you wrote in answer to Jennifer's question about a latching
difficulty caught my eye:

"I notice that babies whose mothers have large, very soft =
breasts and who have been given a bottle (with a ready-formed 'teat') =
often don't seem to have a clue how to draw the mother's soft breast =
into their mouths teh way they need to.  They are used to having =
everything pre-formed and are hard to convince otherwise, especially if =
the teat is long-ish.  They look at Mum as if what she is offering is =
fake."

A technique that I have found works to assist latching a baby to a large,
soft breast is as follows:

1.  Use cross-cradle/prem hold, with baby supported on a pilow, chest to
chest with mother, ie if mother was offering left breast, she would support
the baby's back/shoulders with her right hand, thumb and forefinger behind
and below baby's ears, and proceed as follows:

2.  Support left breast with left hand.  If breast is *very* large, use
rolled wash-cloth between chest and breast for extra support.

3.  Cup the breast under/behind the areola with the *middle* and remaining
ring and little fingers, in line with baby's smile, leaving thumb and index
finger free.

4.  Now ... with thumb and index finger mother takes a "pinch" of that very
soft areolar tissue, just beside the nipple (that would be about 3 or 4
o'clock on the left breast) - this makes a kind of "handle" for the nipple,
which can be stretched forward.

5.  Dab baby's lips with the nipple to stimulate a wide gape, now use the
"handle to *put* (stretch and place) the tip of the nipple up into the
baby's palate.

6.  As the baby feels the stimulation up in the palate he will "latch".
Continue to support the breast underneath very well with the third finger,
but when mother feels the baby "tug" the tissue as he sucks the nipple into
the latch, quickly let go with the thumb and index finger, leaving just the
nipple/areola in the baby's mouth

7.  Voila - baby is latched on to that oh-so-soft breast tissue.

This technique works best when the tissue is very soft (elastic).  If I am
helping a mother with these kind of breasts who just can't manage it
herself, I often teach the baby first myself, and then show the mother what
to do when she can see that it works.  I stand on her right so that I can
see the baby's lower jaw, and up into his palate, and I use my left hand to
create the "handle", with my thumb underneath and my index finger on top, at
about 9 o'clock on the areola.  I use my right hand over the mother's left
hand to bring the baby on to the breast as he gapes, and then stretch and
place the nipple up into the palate, wait for that little tug, and quickly
let go. Respectfully, of course, nothing should hurt, or be rough. The
breast needs to be well supported from underneath or the baby will slip off.

I usually find that the baby may only need this special help for several
consecutive breastfeeds, and then he learns to create his own teat from that
soft tissue and the mother can then just offer the breast in the usual way -
cupping, stimulating gape and quickly bringing baby close enough to get a
reasonable mouthful!

Pamela Morrison IBCLC, Zimbabwe (who doesn't believe that nipple-confusion
needs to be a problem if you can get the latching right!)

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