Any latch technique or positioning option can be implicated with sore
nipples if the baby over-shoots the target and locates jaw compression on
the nipple shaft rather than on the areola.  I have a new lecture called:
Re-Thinking the Vocabulary of Latch, and it makes the point that so much of
our teaching vocab. is almost calculated to position the baby with jaw
closure on the nipple.  If one tickles the lower lip, baby roots down.  This
tucks in the chin when the chin should jut out.  As Diane Wiessinger points
out in her great JHL article about using the sandwich technique, you want to
plant the chin first.   The baby is induced to open widely by tickling with
the nipple slightly above the upper lip so the baby has to "hunt up".  This
insures the chin in, nose out configuration.

In so many descriptions of latch and in so many institutions, the mother is
advised to bring the baby close by pushing on the baby's head, landing the
nose first.  This drives the nose into the breast, makes it impossible for
baby and mom to look at each other, and, because babies typically have
slightly receeding chins,  jaw closure on the nipple will again occur on the
shaft of the nipple.

To repeat:  If nose is in, chin will be too far out for most babies.  What
is needed is an asymmetrical latch, with slight extension of the head, chin
denting the breast tissue, nose slightly backed away, eyes in a gaze line
with mothers.  When mom looks down she should see both eyes if baby is in
cradle (i.e. baby's bottom shoulder is slightly tucked so bodies come
together like a V rather than two parallel lines.

Cross cradle is a great latch position (and mothers can then slide their arm
into a cradle position if they want).  It works well for babies who need
lots of postural support, because the hand at the base of the baby's head
and the mother's forearm along the torso hold the baby so securely. The free
hand lifts the breast.  This works really well if mom has large or long
breasts, and if she wants/needs to do deep breast compression.

 My guess about why it isn't working is that moms have a tendency to push
the breast towards the baby's bottom jaw during latch.  Instead, they should
lift and support the weight of the breast, start the sequence with nose and
nipple lined up, and wait for baby to open.  Then they need to aim for the
palate and draw baby onto the breast rather than push breast into baby.

I'd bet money that the cross cradle position isn't the problem, it's
adherence to the vocabulary that emphasizes the advice to  tickle the lower
lip, "center the baby on the nipple," bring nose in close.  All this will
put jaw closure on nipple shaft, result in Nuk shape or new-tube-of-lipstick
shape nipples.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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