Since I work on a ward with 25 beds and 50 employees mostly in part-time
positions, it is rare to find a mother who has not been observed feeding by
at least three different people, and often twice that, in the first day or
two after giving birth.  But things can be hectic and the observation can be
cursory, and the person observing may not be expert at detecting problems.

If I had just a quarter (or actually five Norwegian kroner) for every time I
helped a mother with sore nipples get her baby painlessly on the breast, who
had been told by 'everyone' that the latch was fine, based at best on a
glance after baby was already attached, I could have myself a nice
restaurant dinner about every other month.  And if I combined it with a
little extra for every time I am asked about how to get breastfed babies to
burp in the first week of life, I could take early retirement - but that's
another topic.

When I teach, I start by defining good latch as COMFORTABLE and EFFECTIVE.
I am positive I have these words from one of my many books but it's late at
night and I can't find which one it is.  I know for sure they did not
originate with me.  I want to say it's from Bestfeeding but I can't seem to
find the citation there right now.
A latch can be comfortable because baby is just pretending to breastfeed,
thus not effective, and it is possible for it to be effective enough to
satisfy baby, at least early on, but very uncomfortable for mother.  Neither
one of these merits the designation 'good'.   Luckily for everyone, the most
effective latch is usually the most comfortable one too.

Since most of the mothers who turn up for the group sessions we do three
times a week have been on the ward for 5 or 6 shifts already, I feel it is
essential, for diplomatic reasons, to emphasize two things.
ONE: You need to have time to observe the baby as it is taking the breast,
as nearly any baby can suck hard enough once they have a breast in their
mouth to make it look like the latch is all right.  Corollary to this is
that jaw movement at baby's temples/ears is NOT the deciding criterion for
whether the latch is good.  The other corollary is that it may help to
observe the baby coming off the breast too, but if you are present for the
first part you can arrest a painful latch before it does much damage.
TWO: The difference between really uncomfortable and just fine can be tiny -
and we are not always fortunate enough to have the time to stand there
throughout the process so we don't always have all the info we need, but it
is worth it for the mother to persevere, don't accept anything less than
someone helping you til you and the baby get it right.
The diplomacy is because I would like to keep working with these colleagues
indefinitely, and if I come in and say 'WHAT?!! They told you it was NORMAL
to have excruciating pain and bleed for the first week or so??' then my
future looks less than pleasant.  I wouldn't get fired, but I might be
frozen out of the coffee room.   I can tell from the doorway if the latch is
really bad, by looking at the mother and listening to her, and oh how I wish
everyone would accept that breastfeeding is not meant to be painful.  But I
can't tell from the door what the problem is - all I can see is I need to
investigate further.

We have just completed the process of applying for Baby-Friendly status
(Hooray! It looks like we have made it, but don't know for sure yet!) and to
that end we have had intensive in-services over the last 6 months for staff
in which a central theme was observing feeds and assessing latch, and being
aware of problems such as tongue tie or very firm breasts which can impede
or even prevent a good latch.  I'm happy to say that I now notice better
charting and much more focused observations of mothers experiencing painful
feeds.  So, it helps to keep yammering about this.  What surprised me the
most was how receptive staff were to the presentation on assessing latch,
since most of them have been doing this job on this ward for over 20 years.
The shift in attitude towards assimilating updated knowledge about
breastfeeding has been palpable, and reason to rejoice.  I wish I knew what
caused the change, because I was ready for it about 15 years ago, but better
late than never.

Rachel Myr
Kristiansand, Norway

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