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Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 9 Sep 1998 21:20:27 -0400
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I don't see things the way Barbara does.  Babies will breastfeed if they go
to the breast and get milk.  Every day, I see babies who are refusing to
latch on, and I get those babies to the breast because they go to the breast
and *get milk*.  Because of the way they latch on.  Once they get the breast
once, they often do it from then on.  I don't call this impaired, I call
this normal behaviour.  "I want milk.  They are trying to put this thing
into my mouth that doesn't give it to me. They must think I'm crazy.  I'm
not going to."  Some babies don't fight the breast.  Many, perhaps the most
just sit and suck, until the milk "comes in", and then all is fine, usually.
Some just go limp and don't do anything, and they are at risk for
dehydration and worse.  So why doesn't it happen with a pacifier?  Because
it is much more difficult for the baby to refuse a pacifier, it can be
forced into his mouth.  Unlike the breast.

I'm not saying that the bottle is worst thing in the world.  Just as I don't
think there is never a place for a nipple shield.  But we (present Lactnet
company excluded, of course) just use them too often, often without taking
the time and the energy to help that mother.  I saw a mother today who got a
nipple shield on day *1* because the baby hadn't latched on.  I can tell you
one thing.  I get those babies on the breast sometimes after 30 seconds of
finger feeding, when they wouldn't go near the breast before.  I think this
is where we are using finger feeding wrong.  It's not "Well, we've tried for
a long time now, and she's gone ballistic.  Just finger feed her and we'll
try again next time".  Uh, sorry, finger feeding is to prepare the baby to
take the breast.  And it works often, if used properly and early.

Look.  There is a problem called nipple confusion.  What do you all say to
this (true) case?  A mother goes on flagyl when the baby is 6 weeks old and
is told she must stop breastfeeding (didn't check with me first).  The baby
has never in her life had a bottle or pacifier and the breastfeeding is
going well.  After 10 days off breast and of mother pumping to maintain
supply, the baby is supposed to go back to the breast and goes nuts.
Despite an abundant milk supply.  Despite everything I and others tried to
do for her.

What we all have to understand is that there is a range of normals here, all
the way from the baby who *seems* to accept both breast and bottle, to
refusing all artificial nipples, to refusing the breast.  If the mother has
an abundant supply, the baby will often accept both.  If not, it will not
take him long to figure out where the milk is coming from. Unless we
understand that, we will never help other health professionals understand
breastfeeding.

By the way, babies died in the old days for many reasons.  I doubt that
sucking dysfunction was a common reason.  Because women knew about
breastfeeding, and knew the baby wasn't doing well.  They would feed with a
spoon, and those of us who work with mothers from Africa or Afghanistan or
Vietnam realize they all know how to feed a one day old baby with a spoon.
That's how babies with cleft palates were fed in the old days.  Far more
common probably was the use of prelacteal feeds (often contaminated), and
early introduction of inappropriate foods (very common in Europe,
incidentally).

Jack Newman, MD, FRCPC

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