Dawn writes:
>Sometimes I know that the only thing I know for sure is--
>breastfeeding works.  Temporary solutions for temporary problems!

That is the basic position.  And why are we surprised that different
techniques work for different babies?  If all babies responded in the same
way to a given stimulus we would be out of a job.(Nice thought, isn't it?)
We need a large "bag of tricks".  When working with a mom and baby I stress
that there are several ways to help this baby to learn to breastfeed well,
but her baby is unique and we don't know which way will be best for
her/him. We also don't usually know for sure just what is going on in that
little mouth. (Because as has been brilliantly pointed out on this list,
babies don't come with transparent cheeks.)

So, if baby's tongue stays humped up or she is not opening her mouth much,
I try fingerfeeding.  *Sometimes*that tells her that she must open wide and
that with her tongue curling around the finger, which is far back in the
mouth, she gets more milk.
When I see that this approach isn't moving her toward the breast, I go to
something else, such as cup feeding.  *Sometimes* that tells her that if
she wants to suck she has only the breast to enjoy.

If baby's tongue is glued to the roof of her mouth, I remember what I
learned on this list-that it could be thirst-and I use cup, spoon, or
dropper to "wet her whistle." *Sometimes * that is all that is needed to
get this baby to feed at the breast.

With some babies I use a supplementer, with some an eye dropper, some a
nipple shield, some cradle hold, some side hold, some begun when hungry,
some begun after hunger is abated a bit--and *nothing* works all of the
time.

The one important line that I have is, "There is plenty of time."  This
helps parents to not give up on their little one's capacity to learn.  By
stressing that it is the *baby* who is learning to breastfeed, moms are
usually more patient than if it is *she* who is "incompetent." I liken it
to teaching the child to ride a bicycle. The child will fall off and cry
that she will never learn. The parents comfort and encourage her to keep
trying, and one day she rides and there is joy all round. The parents have
to see the big picture when the child can't.

Sometimes parents choose to give a bottle of Expressed Human Milk (EHM).
*Sometimes* that gets the baby and mom relaxed and, with continued offering
of the breast, baby latches on and is a fully breastfeeding baby. I have
worked with several babies who were taking milk from a bottle, with mom
offering the breast at every feeding and with lots of skin contact and lots
of patience,  who one day latched on and never looked back. If the parents
know that it is worth all their efforts, they will not give up. That is the
BIG "IF."

Talk about technique...I was working with a mom once (actually I've done
this more than once) and we were standing  (taking a break) with mom
undressed and with me holding the baby.  I saw those great nipples dripping
milk and took baby over and "fwomp"* baby latched on and had a nice
feeding. Now, this isn't standard technique :) and isn't what parents want
to do several times in the night, but what it did was show this mother that
her baby could, in fact, feed at her breast and wanted to do so very much.
We examined what enabled baby to latch on in that position better than what
we'd been trying, and soon baby was feeding happily at the breast. (With
mother in a chair.)

Now, I admit that sometimes *I* don't know if "there is plenty of time",
but I say it anyway.  I'm sure that there are some babies who won't learn
to breastfeed, just as there are some who won't learn to ride that bicycle.
 But I'm betting my energies on "this" baby's wanting to feed at her
mother's breast as much as we want her to. And we just have to give her
time and encouragement--and some expertise on the part of the LC, with her
bag of alternatives gleaned from other practitioners.

We'd all like to have it simpler, of course.  If baby won't go to breast,
then do "this" and next feeding she is at breast. The conference speaker
that you mentioned was probably wanting a sure fix. But, I have found, that
*no* one method works for every baby. Much of the problem with today's
"medicine" is that everyone is treated as if we are all the same.  It's
simpler than seeing what a given patient really needs. Some mothers pass on
STD to their babies so we put drops in all babies eyes.  Some mothers will
not be able to birth without drugs so we drug everyone.  Some people need
iron supplements so we "iron" everyone. Some infections call for
antibiotics so we give it for everything. And on it goes.

I do understand that the hospital setting is quite different from my being
in the home with one mom and baby for several hours.  Oh, I understand so
well!  Those who share your work scene will have good ideas to share, and
we all need to remember that every baby and mother are unique and with
different ways of learning. Every LC has her favorite methods, which became
her favorites because they worked a lot of the time.   On this list, we all
know that there aren't set solutions to a given challenge and we are all
eager to learn what others have done with such a challenge. We just have to
try to pass along this openness to those who want simple solutions to
complex problems.

So when we hear of another method of getting a baby to breast we don't need
to throw out our old ways. As Lisa M said, ( and said it much more
succinctly, of course) "breastfeeding problems do not all fit into the same
box."  We just put the new method into our kit of alternatives.

...besides, continuing to meet our challenges with openness and creativity
keeps us all enthusiastic for our work and mentally sharp. And all of these
challenges keep us humble.

*My spell check didn't recognize "fwomp."  Oh, the limits of technology!

Patricia Gima, IBCLC
Milwaukee

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