Lactnetters,
Pam says, and I agree "my personal philosophy is - if she's not sore, baby
is getting good milk transfer, and both she and the baby are comfortable,
then go for it. I believe that for every mom/baby couplet there are that
many holds and latch positions."
This is true, and the thing that I find most problematic is the MILK
TRANSFER. First you must know the context in which I am assisting mothers.
Highly medicalized births, routine separation of mother/infant, very few
early breastfeedings, rampant use of supplementation, etc. So you must know
that the "normal, natural" is not occuring much. So I guess I am there
trying to "rescue" breastfeeding. Unfortunately, mothers left to their own
devices often achieve very poor latches, which I don't find to be causing
much nipple pain per mother's reports, but very poor or even no milk
transfer, as evidenced by lack of a nutritive sucking pattern w/ swallows.
By the way, for most mothers, in my experience, and even at the very first
feed, a nice rhythmic nutritive sucking pattern is seen when a good latch is
achieved. So it is very painful for me to (however gently and tenderly)
guide mothers to a different use of positioning, since many mothers are
quite resistant to vary the positioning they are using, even when the baby
is very flexed and basically perched on the nipple and just flutter sucking
or sleeping there. It is quite obvious to me that when said mother is shown
another position (I favor the clutch or cross cradle hold) the baby achieves
a good latch and the milk transfer is very evident. This reinforces the new
position for the mother, seeing the active suckling and longer feed. I truly
wish I could become expert at facilitating the cradle hold and seeing a good
feed done w/ it on a newborn. I have not been very successful w/ this
however.
The cradle hold seems to favor neck flexion, tucked chin, and a blocked
nose, maybe because the moms are medicated and the c/s rate is high. It
seems to work better with smallish babies and smallish mothers/breasts. Our
population has a high proportion of obese women. This is another great
challenge for positioning and latch. I hope I am not coming off as
insensitive and I guess I am rambling at this point, but I find more
couplets are having "good" feeds with the clutch (especially) and the cross
cradle, so I use them. I agree, too, that some mothers, who are themselves
large and have large breasts and coupled with a big baby, have quite a bit
of trouble with the cross cradle. I also wonder, if left to their own
devices (wt loss and jaundice notwithstanding) these couplets would indeed
figure it out and latch and feed maybe not right away but in a couple days.
However, I am not comfortable, in the environment I practice in, to leave
them alone to that extent. More discussions welcomed. I am open to learn any
and all.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA
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