> So, I do assisted attachments and I will keep doing them.  I'll be
careful,
 > I'll be gentle.  I don't believe in either extreme.
 > -- Carla (just north of Washington, DC)
Carla:
     You expressed my opinions and described my stand on this issue
 perfectly!  I've been wondering if I'm the only IBCLE out there who is
 trying to reach a compromise between the ideal (self latch - no time
 constraints - no worried parents who are being told by other staff or
 family that the baby is in danger of starving, repeated heel sticks for
low blood sugars, etc); and the reality of hospital practice.  I, too,
consider my methods of assisting with early latch on to be just that:
assisting mom and baby, not forcing or "violating" the baby.  If I sense
that mom is not happy with the way I am hadling baby or breast, in spite
of having given me permission to touch first, then I let go at once;  if
the baby cries, I stop and have mom spend a few minutes just snuggling
and comforting him before I try again.  Our hospital policy states that
baby must feed every 2-4 hours with one allowable 5 hr. stretch at night
for breastfed babies.  If I am not able to get the baby attached and
"nursing well" during the few hours I am there, there is a very strong
chance he will have one or more bottles of formula before I return the
next morning.  I often use gentle downward chin pressure to help the baby
open wide (not force his clenched mouth open!), pull him firmly to the
breast by the back of his shoulders (not push on his head!), and hand
express colostrum to entice him to begin suckling.  I do not consider
this RAMing or undue force.  Whenever possible I like to teach Dad or
whoever will be there with Mom during the first few days, to assist her
in the same way I do. I let them know that very quickly the baby will
become expert at getting on, and will no longer need any help.  Thank you
for so aptly describing what you do.  I'm glad I'm not alone!
                                         Anne Stiller, RNC, BSN, IBCLC