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Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 20 Aug 2009 07:45:27 -0400
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Dear all:

When I assess the attachment, the two key things I focus on are maternal pain and how 
the baby is swallowing. If there is no pain and the baby is swallowing well, i leave it 
alone.  I never attempt to assist the mother until she shows me what she does (with the 
exception of mothers who have been in extreme pain and are extremely afraid of 
attaching their babies).

The research shows that visual observation of swallows is not as accurate as test 
weighing, but much of this research is based on test weighs after the first three days of 
life (I read a huge pile of original research).  So in the early days, I would observe and 
listen for swallows.  Assisting mothers to observe, listen, and feel for swallows can 
empower her to understand her own babies cues.  (In fact, the noise that is commonly 
heard is actually the exhalation after the swallow, not the swallow itself).  This can be 
important for breaking the cycle of mothers relying on "time" and "rules" for when to 
switch their babies from one breast to another.  It can break the cycle of using 
"schedules" as opposed to developing health "routines" based on a mutual understanding 
of cues and responses.  I've always hated the terms "baby-led" and "mother-led" and 
found a nice article by Beatrice Beebe who does research on attachment theory.  Her 
article was very hard to read, but the essence was that you are dealing with the baby and 
the mother as individuals and the baby and the mother as an interactive system --- really 
three systems going on.  The baby and the mother may independently act quite 
differently with other individuals.

Only when the mother and baby are out of sync with each other do I use any of my own 
visual observations about the attachment and even then I will always ask the mother how 
it feels to her rather than make assumptions about what I think would feel best to her.

For that reason, I really don't use any "latch assessment tools" other than the mother's 
sensations and the baby's behavior.

Somehow, I have this feeling that when I retake the exam, I may do much worse than 
before because I will probably feel compelled to write essays for every exam question. 
The first time around I had a hard time because I wanted to do that and the next time I 
probably won't be able to stop myself.  Every exception came to mind for all the clinical 
questions. 

Best, Susan Burger

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