This is in response to several Lactnetters who have posted on prescriptive
methods of "positioning", reducing choices to a set procedure for
"positioning". I agree that it comes down to looking at the mother and
baby's comfort and how best to use the baby's skills for the least energy
expenditure and maximal efficiency. I was appalled, back in 1988, when
people who'd attended a breastfeeding conference in Melbourne came back
promoting the idea that "it's all positioning" and that if positioning were
right, everything would be right with breastfeeding. What's more, my use of
a variety of positions, including a laid-back one, marked me as a heretic
for years.
Over the next few years the majority of mothers I saw had babies who were
pronounced as having textbook-perfect positioning - but the mothers were in
pain. Of course, the external appearance wasn't a good indication of what
was happening in the baby's mouth - whereas asking the mother detailed
questions about "how it felt" gave me a much better picture. Sight isn't the
only sense we need to use to assess the situation! I used my ears to pick up
on sounds that indicated that the baby's tongue was not forward and filling
the mouth. Watching the mother's face, I could also see if the slurpy sound
or click coincided with a change in "how it felt" to her, even before she
said. Listening and asking were better than just looking.
"Perfect" positioning was also supposed to guarantee good growth - but
people sometimes forgot to check if the mother understood about feeding
frequency and was spacing out the feeds.
Like Wendy Blumfield, one of the first things I help the mother with is
whether she is sitting comfortably. For many years one of the factors I've
looked for when observing mother and baby, and seeing what they are actually
doing, is tension in the mother's shoulders. In fact, looking at the
shoulders in the batch of pictures I was sent for the front cover of the
last edition of one of my books (1991) helped me to narrow the choice. If
the mother's shoulders looked tense, that photo was eliminated from
selection. I still look at shoulders today. If we can get mother, as well as
baby, comfortable she will be willing to breastfeed and do it as often as
needed.
From the late-1980s, a particular position came to be taught widely in this
country as the "correct" way, as it enabled a mother to take control -
clutch and shove (and override the baby's attempts sometimes). This
particular "hold", was so awkward that I was unable to achieve it myself for
many years. If I couldn't do it, how good was it for a lot of mothers? When
it didn't work, or wasn't comfortable, mother and baby would become so
frustrated with repeated attempts to latch.
It is helpful to ascertain what needs to be achieved, and then work with the
mother and baby (and support person as observer, if relevant) to help them
get it right - for them.
I do find it can be helpful to use positions where the mother's body is
supporting the baby and the baby has the opportunity to self-attach and use
her/his hands optimally. For instance, when mother and baby are frustrated,
latching has become a fraught issue, and it is not working for either mother
or baby. What works for *that* mother and *that* baby is what is important -
the mother needs to feel okay about doing it without me there.
Other strategy I use when mother and baby are frustrated about latching is
to get them to stop, take a short break with Mum walking round or standing
and stretching. Or I may go out of the room to give them space. So often
I've noticed mothers get a more comfortable latch after they've gone home
and had a nap, and something to eat. (When they are tired or their blood
sugar is low, they aren't going to do as well as when they are rested and
have had a snack.)
I guess the above is reiteration what has already been said.

Virginia 
(back on Lactnet after a long absence)

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Continuously certified IBCLC since 1985 (original cohort)
Brisbane, Queensland, Australia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Wendy Blumfield wrote (in part):
I do not understand why we have to put labels on positions for breastfeeding
or promote or "certify" one position over another.  Both in preparing for
breastfeeding in my prenatal courses and in visiting new mums in the
hospital or at home, I start with "Are you sitting comfortably?"....

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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