I have many times found myself on the "horns of the dilemma" that Susan
and Heather debated so thoroughly. Especially when I am dealing with moms
of any income level whose educational and cultural conditioning and
SUPPORT SYSTEM consider a bottle as normal and essential and innocuous a
part of baby care as receiving blankets and disposable diapers.
I think it is essential not to alienate them with references to
"uncommon" (to them) practices that might automatically seem to classify
their relatives and friends as "second class" mothers! This will not
succeed if it places them in a position of having to argue with or defy
their support system when they get home.
That is one reason I have found it very helpful whenever possible to
include in a teaching session the person who will be the mother's primary
breastfeeding support person at home. This is as often, or more often
grandma, or sister, or aunt, than dad.
No matter how carefully it might be phrased in prenatal class, mothers
(and dads) are in a very vulnerable time in the hospital. It is a fact of
life at this moment in time in OUR community that most short-staffed
hospital personnel DO use a bottle as a vehicle of choice if they think
it's necessary to invoke Rule #1. Feed the baby.
And only the person who has stood at 4 a.m. by the bedside of a sleep
deprived mom who labored all night the night before and has had no
consistent sleep since, and is due to go home in 6-24 hours can imagine
the near-despair the mom may express. Especially if this is her first
experience.
I am so impressed with what I have heard referred to as the "Australian"
position, I guess because of explaining it in relation to the platypus. I
wish there were a way to pour this information into the heads of all
hospital personnel, especially in L&D. This would be a great way to start
out the first feeding, extolling its benefit not only in allowing the mom
to sleep on -and on- and on while baby feeds, but for its use of gravity
to assist in the depth of the latch.
It would also be a great time to teach dad, or grandma and all the other
significant others around that while mom and babe learn, 3 hands are
often required to start. Of course, when the electric bed is available,
mom can start out by herself in cradle hold and lower the head of the bed
so she is in Australian position, as long as she has a pillow under the
elbow cradling the baby's head.
Or mom could be sitting up and use cross-cradle hold to latch the baby by
herself, with others standing by to support her and prevent abdominal
strain as she eases down on her back. They could then position pillows
securely and help roll the baby further over "up on" mom, if needed.
It would also be a wonderful position to teach prenatally in BF classes,
even in CBE classes while the dad is already down on the mat changing
roles to experience how hard it is to learn to tense one part of the body
and relax another while learning to develop a conditioned reflex for
labor, and to reduce later sleep deprivation.
For those not familiar with it, I have simply advised 2 pillows under
mom's head so she can have some semblance of a view of what's going on on
her chest without straining. Another pillow tucked firmly under her
head-cradling elbow seems (to me) essential to success, especially if she
is large busted, and needs to "cradle" it as well. And of course, if
another pillow were available to tuck under the other arm, she could
cradle babe with both almost as if she were crossing her own arms over
her lower ribs.
A third person places the babe on its tummy on mom. Hips and legs can be
placed straight across mom's other breast with toes directed toward her
axilla, (which I like best for starters). Or toes can be pointing to
either hip at 5:00 or 8:00 position, for a variety of positions
throughout the hospital stay to rotate jaw placement regularly to various
milk sinuses. Each of these positions avoids pressure on a C.S. incision
as well.
With a little colostrum expressed on the nipple, so many babes placed in
the PROPER RELATIONSHIP to the nipple will go "right to town". If the
relatively heavy weight of the newborn's head is practically
perpendicular to mom's chest wall, it encourages the babe to relax and
sink deep on to the nipple-areolar complex rather than to rear upward, or
slip off, etc. Then mom can relax, without fear, and snooze to her
heart's desire!
I think this kind of teaching in my community, starting prenatally and/or
in L&D, could kill so many birds with a single stone! Does anyone else
see logic in this? If you do, I invite you to share this hint with anyone
you think might be interested.
Jean
--------------------------------------
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio
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