I have a question for the list. Since I can't imagine another forum that would provide me with the depth or global perspectives that Lactnet can provide for this question, I'd like to take this opportunity to thank Kathleen Bruce and the other list-mothers who have given us this unique gift for their well-deserved award. Wow! (And, really, it's about time that you received some recognition beyond those of us here!)

Question: A midwife friends works a few weeks, several times a year in the Dominican Republic. Where she works, BF is the norm. But the position the mothers use is very hands "off." The baby essentially rests in mother's lap and she bends over to provide the breast. There appears to be obvious tension on the nipple/areola due to positioning. However, any attempt to offer other ideas is met with "non-compliance." (That word has NO place in healthcare; check its definitions. When I hear it, it's like fingernails sliding down a chalkboard for me! Why would we want passive, wimpy clients vs. engaged persons who want to be involved in healthcare planning. Stepping off soap box.)

Back to the question, not only are we wondering if this is just a cultural piece, she's also thinking it should hurt. However, she says this is a non-complaining culture -- never admit to pain no matter what the circumstances. So she's wondering if these moms are in pain and not complaining. I'm wondering if a "detached" sort of BF is a part of socialization that evolved from high infant mortality and this position is less attachment oriented. 

Would love other perspectives on this...and, if it probably is painful, my friend would like some hints on how to approach these mothers in a more culturally competent way.

Karen

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