Laurie asked about

My boss  will be giving me
further details on this soon, but I thought I would ask  now and if any of
you have such a system, would you be able to share it  with me? If anyone
else has any ideas as to how to describe the 4 levels,  feel free to chime
in. Thanks.



I don't know how your boss decided that there should be four levels,  Laurie.
 I'm not saying that something along those lines might not be  developed.
But I've seen too many psychological and just plain body
comfort/abilities/awkwardness issues that would make a particular mother/baby  dyad hard to predict
or categorize this way. And when would these levels by  assessed?  Six hours
after birth/ Twelve hours after?   24?

It sounds like your boss wants to charge some mothers more because it takes
longer for her and the baby to achieve an acceptable comfortable  successful
level of breastfeeding?? This does not sound like support  nor protection of
breastfeeding.  I do see that that it could help to know  that some mother/baby
dyads might need more support more frequently. And  want to use that for
staffing purposes.  But at the same time I just  don't see that you could proceed
from Primip with no risk factors to an assigned  management level.  Nor for a
mother of her second child with risk factors  for often the baby's makeup makes
all the difference.

 For instance, a particular mother might have soft breasts with  nipples that
are elastic and not flat, and a baby that is starting to open her  mouth and
root well so assigned to a low management level. But the mother might  be
taking a long time to learn how to hold the baby so that he doesn't slip  away
from her, or she might keep on moving and planting the baby firmly on the  crook
of the elbow too far away from her breast - no matter how softly and  gently
you show her with a doll model or describe to her what she is doing. Some
mothers want to do it themselves and resist teaching initially. This  type of
mother may eventually figure it out on their own or learn  what she specifically
needs help with on her own. Or may not.

Or given that same initial evaluation another baby might keep putting  her
hands in the way just as she is brought onto the breast, blocking her latch.  Or
that baby might be doing something with her tongue so that the latch looks
"perfect' from the outside, but the tongue could be thrusting, or held back in
the mouth.  Another baby might get on the breast so well and then  suddenly
slide off to the side losing hold of the breast.  [We figured  out by observing
a baby doing this that he had been pushing his tongue  against this finger
tips most likely in utero and after some sucks did the same  thing - pushed his
tongue forward and abruptly dislodged himself from the  breast!  It took days
to change this already established habit.]

 (By the way it's often the staff that tells a mom the latch looks  'perfect'
and then I walk in, find out there is pain, some nipple trauma and say
something is going on and let's see what we can find out.)

I see a mother and baby progress at their own unique rate as each day
passes, learning in a way that isn't necessarily replicated by another mother  and
baby who initially might have the level of parity and exact type of
breast/nipple and baby who opens well. Can you predict which mother is which at  the
start? Are we giving the moms personality tests? Myers-Briggs for instance?  One
mother/baby dyad who on the first day may be doing wonderfully on the  second,
while the next dyad with the same initial presentation may take three  days
to get to a similar place.  Will each level of these four have  subdivisions to
map out the myriad of subtle differences that occur?  Awkward mother not
physically comfortable, but slowly learning? Awkward mom with  a baby doing
something funny with tongue and mother experiencing pain and  frustration by the end
of the first day?

Or a mother might have upright firm breasts, but a long trunk, and  long baby
who only achieves a comfortable latch with the mother leaning back
elongating her trunk and letting the baby's body angle down it rather than  sitting
upright when they latch. It might take a few days to figure all that  out.

The baby's contribution can be a tremendous factor.  A mother with  flat
nipples might have struggled for days with her first 'slurper' baby  and
categorized at a different risk & managment level, but this second might  latch like a
pro by the end of the first day.  Or with the help of the type  of positioning
in the "Follow Me Mum" video the mother might learn a different  way of
latching this baby that works well in one session or in five.

I've seen too many mothers with no risk factors take longer to finally say,
"I think I've got it" than many mothers with risk factors.  So I wonder if
this style of evaluation would be at all effective, or just one more thing the
staff would have to chart without any real prediction of outcome nor
designated  management level.  Things change so fast in the first two days.

I'll be interested to see what others have to say. You got me thinking at
any rate. Thanks,

Mardrey Swenson



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