I was thinking about Vicki's comments on knowing normal breastfeeding as
a means of spotting what is abnormal.  This is definitely very
important.

Since I was in nursing school the year Rob was born, I didn't learn at
that time many of the things which are now considered part of routine
nursing assessment.  When I was in school, my only need for a
stethoscope was for taking blood pressures.  I was evidently out of
nursing when listening to lung sounds became part of the nursing
assessment.  No one ever taught me.  I just listened to lung sounds
until I began to be able to distinguish something that sounded different
from what I usually heard.  I've learned lots of things this way as I am
sure most of you have.

As I think back on my one-week lactation educator's course, I remember
learning a LOT of things.  However, what I don't remember learning were
some really basic things.  I don't remember learning about hunger and
satiety cues.  I learned those from a lecture Vicki gave at a childbirth
educator's course.  I remember learning the importance of nutritive vs.
non-nutritive  sucking from discussions between consultants at local
affiliate meetings.  What helped me really learn subtle differences
between effective nutritive sucking and a less than perfect latch
accompanied by NNS (non-nutritive sucking) was the video Helping a
Mother Breastfeed.  Most, if not all of these things are things I
learned AFTER becoming an IBCLC.

My point is that I think latch and positioning need to form a MAJOR core
in the curriculum of any lactation course.  NEVER ASSUME basic
breastfeeding knowledge.  There are lots of less important things that
can be given as handouts or can come later from books or conferences.
As we all know, latch and positioning are probably at least 80% of what
we do.

The one thing that I relied most on to tell if baby was correctly
positioned and actively sucking until I learned some of things I know
now was the pulling sensation I could feel when my hand was on the
mother's breast.  I still find it very useful, but can't recall seeing
it in any literature.  I think it is important to teach several methods
of evaluation as each of us uses some senses more effectively than
others.  I seldom hear swallowing--probably because my hearing isn't as
good as it use to be.  But I can use sight and touch to evaluate
effectiveness of breastfeeding.

Just something to think about for those of you who give courses.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA