The posts about this have been so interesting - I'm enjoying reading about
what you observe.  Laurie, your instincts about not interfering too much in
the delivery room are spot on IMHO - this is the time to let baby learn and
explore and not do anything to disturb this special time.  However, I do a
fair number of moms and babies in the situations that some of you describe -
baby goes on to the breast, appears to latch, then starts wriggling about,
pushing with the hands, shaking the head from side to side, etc.  I describe
this in my logs as a "latching difficulty". The baby wants to latch, but
can't quite find the right place.  Usually the nipple has not reached as far
as the'S' spot, the junction of the hard and soft palate, that requires
pressure/stimulation for the baby to know what to do.

What does the nipple look like?  What about the shape of the baby's mouth
and gums and palate?  My personal nightmare is a combination of a baby with
a high arched palate and one of those prominent upper gum lines that so
often go with it, and a mom with short nipples and very inelastic breast
tissue.

If the nipple is normally protruberant I suggest that the mom just tip it
*up* (depress the thumb above the areola) so that the nipple tip hits the S
spot.  If the nipple is short, then mom will have to compress the breast
tissue a la our own Diane's brilliant technique, to create a "hamburger"
shape so that a good portion of areola can be introduced into the mouth and
the short nipple can hit the spot.  I find that sometimes the mom is
hesitant about using a rapid arm movement to bring the baby quickly, and far
enough on, to the breast.  If this is not possible, and if the areolar skin
is elastic enough, then you can teach mom to take a "pinch" of the areolar
skin just beside the nipple and *put* it fairly firmly up into the palate -
once the baby latches (pulls in) she needs to let go quickly, but continue
to support the breast very well from underneath so that it doesn't slip out.
Now, if the nipple is *very* short or inverted, *and* if the breast tissue
is very firm and inelastic then you have problems.  This is when I start
digging in my bag for a shield on about Day 3 - 4 of the birth (Days 1 and 2
mom can express colostrum on to a spoon with which to feed the baby, and
keep practising the latching techniques we've gone through).

It seems to me that whether a baby can latch or not is an extremely
individual variable.  The "fit" of that little mouth, and that particular
breast/nipple is all-important, quite apart from the issues of meds during
labour and suctioning and the baby's maturity and the mother's ability to
work along and around her baby's cues etc. etc.  But I think we really need
to take care of the anatomical aspects of positioning and latching before we
can start apportioning blame (etiology?) to the other things.

Pamela Morrison IBCLC, Zimbabwe (who continues to be challenged by latching!)
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