>Here is my question. I do not see  moms 
>putting their fingers on the nipple when latching. If anything I have them  
>place the fingers back behind the aerola area. This seems to give a deeper  
>latch. I have seen 4 moms within the last week during home visits and this is  
>what I did on each one. I also had them lean back and put the babies in cradle  
>positions. We had instant relief in each mom.

Ooh, this stuff is fun!  I have the sense that we've spent the past 50 years or so taking breastfeeding apart, looking at each piece, and working to put it all back together, with the latest piece being that perhaps *we* don't have to put it together at all, as long as we understand what the important pieces are.  

I'll bet both the approach in the animation (are we talking about www.breastfeedingmadesimple.com?) and the one described above accomplish exactly the same things.  

I'm realizing how valuable it is to have the baby's full front in contact with the mom, with support behind his back and shoulders.  Holding a baby that way mimics the way a baby - or any other mammal baby - makes contact with the ground while lying chest-down, a position that all mammals find secure.  It's not uncommon for a confused baby who is given full-front contact with his mom to gape immediately, just as the textbooks say he should, once he feels secure enough to think about lunch.  Having the mother lean back allows gravity - rather than the mother's hands or arms - to press the baby against his mother and accomplish the same thing.  Either way, you're likely to get a good gape pretty quickly.  

Rebecca Glover and Sue Cox, among others, realized that it doesn't much matter where the "upper-jaw finger" - the mother's finger that's closest to the baby's upper jaw - is, since the upper jaw itself doesn't matter much and mom can scoot the finger out of the way just before or even after the baby latches, without affecting the latch.  All that finger is doing is exaggerating the nipple tilt away from the baby.  It's a tilt that occurs naturally (our nipples don't usually point straight ahead but rather slightly to the sides) so that a baby facing our breast straight-on takes not a symmetrical bite but an off-center one, with more breast on the lower jaw than the upper.  That upper-jaw-finger near the nipple base just exaggerates the nipple-above-top-lip approach.  And it's in a good place for mom to do a little last-minute tuck if she chooses.  Leaning back causes the breasts to fall to the sides, and does pretty much the same nipple tilt.  So can holding the breast with the fingers off the areola.

Using just one finger to tilt just the nipple feels to me like a step closer to simply bringing the baby to the mother's chest and letting the latch happen.  If a mom can latch her baby without touching her breast, then she has a baby latched exactly where her breast *is*, and she needn't continue to hold her breast throughout the feed.  

I do sometimes find a baby latches much better if the mom holds her whole breast and narrows it for the baby, but I haven't figured out yet whether those times are a result of me (my one-or-no-finger description to mom isn't clear enough) or the mother (too much cultural baggage for her to respond appropriately to the baby's movements) or the baby (too confused by an odd perinatal experience to react normally).  Maybe it can be any/all of the three.

What all these ways have in common is the way baby and breast come together.  And probably, if you look at that cradle hold, the baby's head *isn't* tucked chin-down into the crook of mom's arm.  Probably baby's head is falling freely off her forearm or wrist in something different from the classic cradle hold.

In fact, if we asked someone who knew nothing at all about breastfeeding to describe one of the good latches we help mothers achieve, the description might horrify us.  Many of us (I did this for years and I'm sure still do) *think* we're helping a mother do A, B, and C, when actually we're helping her do D, E, and F.  I still feel like a beginner, but at least I'm realizing that there are all sorts of subtle differences in how we all come to the exact same result.  Very cool!

Diane Wiessinger, MS, IBCLC  Ithaca, NY  USA
www.wiessinger.baka.com

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