Hi all
 
I am not sure that the position of baby is critical for a baby to suckle.  I
believe what is critical is allowing the baby time to self-direct his/her
own feeding.  Some babies may need a more support than others e.g. Unwell
babies, or with various syndromes or difficult labours, but I find that most
babies are able to suckle effectively if we understand how they do it.  Let
me explain.
 
I began looking at mums who were feeding painfree and baby was thriving.  I
noticed that mum simply exposed her breast, mum held baby close, baby
located the breast and the nipple, extended their head, gaped and took a
mouthful of breast tissue. Hands could be any where.  Head could sometimes
even be turned toward mother, in fact it did not look good but mum was in no
pain and there was good transfer of milk.
 
In 2000 I went to an international conference where Nils Bergman was
speaking and learnt about the wonders of skin2skin.  I saw babies move, seek
out the breast and suckle effectively.   I watched a video "Mandy and Matt"
that showed the instinctive behaviour of babies at the breast taking the
breast unaided.  A 2 years later I heard about Sue Cox (IBCLC -one of the
first) explain about the importance of instinctive behaviour.  I then heard
and read about Tina Smilie and her work on self attachment.  Then finally I
decided to try it for myself.
 
It is this - I put everything that I had been learning over the years
together and let go of what I had been doing.  So this is what I did.
 
I explained skin to skin and told the mums that baby was born to breastfeed.
 I painted a picture that humans were members of the animal family that
carried babies (thanks Nils)  I then encouraged the mum to do skin to skin
and got them to watch their baby.  I encourage mum to support the baby under
bubs bottom.  I find baby will make their way to nipple, will lick,nuzzle
and massage (paw) the areola area (or near it), extend and then take a
mouthful of breast tissue.  Sometimes mum instinctively shapes ( or supports
breast tissue) and this is fine but they can do it numerous ways. I find
that majority of babies suckle with minimum entervention.  The more mum does
(including how to position) the less successful and the more times mum has
to detach and try again.  
 
The next step depends on the age of the baby, hydration states, type of
labour and mother.  
 
I am finding that sometimes the position the finds himself is looks very
wrong but yet the mother says that for the first time breastfeeding is
enjoyable and baby looks as though he is enjoying his feed.  
 
I now do not talk about positioning and attachment - but rather optimal
breastfeeding environments that allow the baby to do as much as possible. 
In the local hospital, they have taken this seriously and the first line of
attack is skin to skin and time.  Interesting, since they have been doing
this, they have found that that babies who have not been able to breastfeed
in the first day have underlying eitology - one had hirsprungs the other had
an asymmetrical face.  Skin to skin and time - are the first lines of having
 successful breastfeeding.  Using skin to skin and self directed feeding, we
seem to be able to find more quickly the baby who needs more support or is
sick in some way.
 
My partner, Joanne, recently talked to midwife researcher who is looking at
the effects of non-intervention on the part of midwives and mother.  Joanne
said that while the analysis is in progress, preliminary findings are that
where the midwife has not put the baby to breast but baby has put themselves
on the breast, there has not been an issue with suckling.  I am looking
forward to her results.
 
If you have any questions I would be happy to answer them.
 
KInd regards
 
Ruth Fiedler
Australia

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