Barbara says:
>I feel absolutely positive at this
>point that the only babies who WON'T breastfeed are babies who CAN'T
>breastfeed.  They don't have nipple confusion, they are impaired.  How they
>are impaired, whether we can alter that, how long it's likely to take, and
>what we need to do to feed them humanely in the interim is the basis of my
>practice today.

I think that you may be talking about something beyond the "usual" here.
To my reading the word "impaired" implies damaged, and very difficult to
correct. I assume that you aren't talking about epidural-induced
incoordination of suck, or oral aversion due to deep suctioning, etc. These
could, of course, cause a baby to be "temporarily impaired."

If a newborn comes to her mother's breast and the areola is swollen with
edema from Pit or such, she can't latch on--yet.  She won't because she
can't (yet), but I wouldn't say that the baby is impaired. Maybe it is
semantics, though.

I began working with a baby of 2 months.  He had been unable to latch,
probably because of edema, as the births were induced with all of her
babies (with much edema of hands feet and legs), all of whom couldn't
latch.  Mom had been pumping and bottle feeding. This baby had learned a
way of feeding with a bottle that wouldn't work at the breast, as there is
a difference (see below)--what I would call nipple confusion or nipple
preference. He couldn't feed at the breast because he didn't know how. She
cup fed him for 4 days, offering the breast often, and on the 4th day he
got it right and was one happy boy at the breast. Perhaps he was
experientially impaired.

I also worked with a 2 month old preemie who had just come home.  He
couldn't feed at the breast because he didn't know how. It was tough but he
learned in a few days. But each time mom gave him a bottle he would
"forget" how to feed at the breast and would struggle for a few feedings
until he got it again.  After he had been at the breast for a month, he
learned to feed in the two ways and was able to have a bottle while mom
worked and to continue breastfeeding.

In prior posts of yours, you write:

9/15/96 "In breastfeeding as I understand it, the anterior tongue extends
to the lower lip line, the tongue grooves around the nipple, and there is
no lapping motion.  The tip of the tongue stays curled around the nipple.
The posterior tongue rises in a peristaltic wave to compress the teat
against the hard palate, moving the bolus of milk to the back of the throat."

4/26/98 "Imprinting is a phenomenon which occurs in many young animals after
hatching/birth.  During this sensitive phase, they become conditioned to
stimuli, and their experiences begin to define what is "normal" to them.
Thus, if a normal stimulus (like the impression made by a soft, maternal
nipple which baby sucks in) is replaced by a larger, stiffer, longer object
which is poked in, the "Super-stimulus"  replaces the baby's normal
expectation with a larger-than-life expectation.  This change in the normal
order of things is part of how I describe "nipple confusion."

Has your study with Wolf and Glass superceded your above assertions?  I've
often thought of the courage a person would have to have in order to write
a book.  Her firm assertions are there, then she learns something totally
opposite, and those old books are "out there."

I know that there are babies who are impaired in their suck, swallow,
breathe coordination, perhaps caused by their medical cocktail, or by their
untimely exit from the womb. So, in these cases, I would see it as they
won't breastfeed because they can't *yet.* In most cases, I see it as a
waiting or a learning "opportunity.

Perhaps I don't understand the time frame of which you are speaking.  Are
you speaking of a newborn?  She won't feed because she can't and she is
impaired?  Or are you speaking of one whom you have worked with for quite a
while, who still can't feed?

I have my specialists whom I refer to, but most of my cases are of a
learning nature-just a few days of training or positioning, meanwhile
feeding in a way that doesn't interfere further with the learning. So I
don't believe that these are the babies whom you are speaking of, or that
Wolf and Glass are writing about. I've only heard them speak, so I may be
wrong about the scope of their book.

Could you clarify, please?

Patricia Gima, IBCLC
Milwaukee
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