I feel that you could certainly do a "screening" observation of this
mom/baby's latch.  Sometimes there are obvious things you could catch
and help mom correct.  On the other hand, If you can't see what's
happening to cuse the soreness or if simple interventions don't help,
then I would certainly refer her to an IBCLC.
Re the "LC" in the hospital saying all was fine-first, was this a
Certified person or just someone calling her (or him) self an LC.  Even
with an IBCLC, you don't always have the time to evaluate every nuance
of every mom/baby couplet.  Sometimes it's a matter of "If baby is
nursing comfortably for mom and you see good deep jaw excursions,
everything is probably OK, but call if any problems (including soreness)
develops".  Sometimes ineffective nursing patterns can feel fine at
first, but with time, they begin to cause soreness-on other occasions,
it's sore the first time.

Now to what would be involved in a "screening observation" of a latch:
1-Is baby opening the mouth side before latching?
2-Is mom holding baby in a way that encourages him to tilt his head up
slightly and place his lower jaw well on to the breast?
3-Is mom aiming her nipple toward the upper part of baby's mouth as she
latches?
4-Is mom supporting the baby's head at the neck and shoulders rather
than pushing on the back of baby's head?

As baby nurses, watch for these indications that baby is suckling
effectively:
5-Are there deep jaw excursions with slight hesitations at the depth of
the suck?
6-After baby releases the breast, is the only difference in nipple shape
that it looks a little longer than when it went in baby's mouth?

"No" to either of these would indicate ineffective latch.  If you can
change the first 4 to a "yes", it might be all that's
necessary-otherwise, a further evaluation by an IBCLC would be in
order.  Of course, there are many other "check points" that experienced
LCs use in assessing a latch, but I think these will give a quick
assessment.  Sometimes, correcting the first 4 items is all that's
needed.

Winnie

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