I have to weigh in again on this issue.

I wonder if the term NIPPLE confusion is the problem.  That is, I have
begun questioning if that is really the problem.  Going back to the example
one person gave of babies being "tested" with bottle teats before being
allowed to breastfeed and then going to breast as if it were a bottle
(small mouth, tongue retracted, etc.)

I don't think those babies were confused at all!  They had learned what to
do on a bottle (imprinting, if you will) and were simply trying to do it
again for the next thing they were supposed to suck on!  Is that confusion?
I am not so sure.

When I have seen this (and I have), I use a nipple shield to ease the baby
onto the breast with a stimulation and feel (if you will) that is similar
to what the baby appears to be looking for.  Once the baby settles at
breast (with shield) and suckles well and relaxes (and this is usually VERY
obvious), we then offer baby next breast without the shield and most of the
time, they go back on breast as if that was all they had ever had.

I view this as learning to be creative in order to help baby see what would
be preferred--in this case, opening mouth wide, and recognizing the softer
warm and pliable breast and nipple as what he really wants to suckle.

Do we overuse devices?  Sure we do, which means (to me, anyway) that often
we are not quite as creative as we might be if we didn't have them to use
as crutches.  Don't get me wrong.  I find nipple shields very handy
sometimes, but they certainly are not a panacea for all problems and
whenever ANY device is used that way, it tends to create more problems than
it would solve if used judiciously.

In observing experienced LCs and wannabes, the biggest difference I see
between them (and I suspect this is probably true in ALL professions) is
that the more experienced use FEWER gadgets and gizmos, are more patient,
observe more while saying less (and thus do not overwhelm the mother with
words or recommendations), and seem to know when to make a suggestion or
use something to help the baby and mother over a given hurdle.  The
wannabes are too quick to want to jump in, love the notion of trying this
tool or that one, and clearly by doing so are showing me their desire to
LEARN without realizing that this may not always be in the best interest of
the mother.

If you are wannabes, please do not take offense at the above
characterization.  I am generalizing, but that is what I have observed.
And, there are people who have been in the field a long long time who do
use lots of gadgets.  But in general, the more experienced do not.  They
have moved to what I consider to be a "purer" form of lactation
consultation, in the sense that they are offering recommendations to the
mother in a consultative manner rather than intervening in a more obvious
"let me take over this experience" sort of interaction.

How is this related to the issue of nipple confusion?  I simply wonder if
what we are attempting to describe is poorly named, is a gathering of
multiple situations which have some things in common, but also many
differences, but that by lumping them all together under one term has
served more to confuse US than to enlighten and assist our clients and
their babies.

Anyone else have any thoughts on this?

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"We are all faced with a series of great opportunities brilliantly
disguised as impossible situations."
Kathleen G. Auerbach,PhD, IBCLC (Ferndale, WA USA) [log in to unmask]
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