Like many others, I have been really enjoying the dialog about positioning.

I agree with Cathy Genna and Tina Smillie on the issue of breast support.
If you don't lift the breast, then it won't drop when you let go and it's
weight (as it drops) won't cause the baby to fall off.  I tell parents it is
a Zen thing:  put the baby at the level where the breast naturally hangs,
nose to nipple so the baby has to tilt to reach (insuring that the chin will
be driven in and nose backed away.)  Use one finger above the nipple to tilt
the nipple towards the palate as you hug the baby in along the torso,
emphasizing more pressure on the lower "edge" of the baby (so baby's body
relates like the size of a V.)  This last prevents over-rotation of baby's
body and the obscuring of the mom's view of baby.

However, all that said, the first position I teach is side-lying.  Mainly
this is because I use the baby's ability to self-attach in this position as
part of my assessment.  If mom and baby are undressed, and baby placed on
his/her back, down hill from the nipple, and baby is very slightly rotated
towards mother, the baby should be able to climb up and self-attach.  I
figure a baby who can't has some issues (and there may be maternal anatomy
issues, too).  This is the starting place to explore what could be going
wrong.  It is also the place when I begin to decide what interventions are
going to be needed to return things to normal.  "Normal" would be described
as a functional infant who can self-attach and maintain the milk supply at
adequate levels to sustain good growth.

PLEASE NOTE MY  NEW EMAIL ADDRESS:  [log in to unmask]

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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