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Subject:
From:
"Kermaline J. Cotterman" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 18 May 2002 22:09:45 -0400
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There are several different phenomena that I have seen folks refer to,
using the same term for all of them, and often placing the full blame on
the rubber nipple.

I am guilty of wondering what the big deal was when this phrase first
became popular, as I was accustomed to the casual use of rubber nipples
in the hospital for years, and seldom saw (or seldom recognized) babies
who could not latch. I guess I just drug out the old fashioned nipple
shields if need be.

When the phrase "nipple confusion" first came into use, I often said to
myself "It's not the rubber nipple that's confusing the baby! The rubber
nipple is predictable, always the same shape and size and delivers milk
at the same speed each time. In the first few weeks. It's the mother's
nipple(-areolar complex) that seems changed each and every time the baby
attempts to latch. More engorgement, more nipple distortion, more
subareolar tissue resistance every day, yea, every hour! And the baby's
jaw/tongue is often just not strong enough to deal with it unassisted."

That's what got me thinking in the vein of  postpartum "latchability" -
of teaching the mother to make the human nipple-areolar complex more
capable of "distorting to conform to the geometry of the infant's mouth."
(Michael Woolridge)

Pat said:

<Most the babies I see whose
mother thinks the baby has nipple confusion actually has "breast
aversion"
from a stressful experience involving either poor positioning and latch
or
trying to force the baby to take the breast or inability to get milk.>

I agree that the "breast aversion" is a very important point.
Unfortunately, this often develops from people who are the most
well-meaning and determined to "make breastfeeding succeed", not
realizing that they have begun to make the breast a battleground. Also,
this is how some babies react when the engorgement makes them feel "as if
they are up against a brick wall".

I also prefer the term "flow-rate preference" for some infant reactions I
see or have heard mothers describe during the early weeks. It is very
common for new parents, and families who have bottlefed for generations,
to allow the baby to continue wolfing down a bottle without pause in the
belief that this behavior obviously proves how hungry the baby must have
been.

When I get the chance, I try to reframe their thinking to see this as a
defensive, stressful effort to coordinate sucking and swallowing with
adequate breathing.

If and when they feel a bottle is necessary, especially in the case of
sitters or daycare, I encourage them to insist that bottles be given
slowly with frequent pauses in a pattern more like the
pulse-trickle-trickle of breastfeeding.

Along with that, I explain how the baby might be more accepting if mom
triggers the MER several minutes before attempting to latch, and uses
breast compression if the baby gets frustrated later. If this has been
the main problem, the baby will usually accept the breast and keep at it.

So once again, I think it's important to recognize how misleading
semantics can sometimes be. Parents have often heard this term prenatally
because someone has tried to warn them as if to "indoctrinate" them in
advance, and many get the idea that it's hopeless once "it" happens.

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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