Dear all: When I assess the attachment, the two key things I focus on are maternal pain and how the baby is swallowing. If there is no pain and the baby is swallowing well, i leave it alone. I never attempt to assist the mother until she shows me what she does (with the exception of mothers who have been in extreme pain and are extremely afraid of attaching their babies). The research shows that visual observation of swallows is not as accurate as test weighing, but much of this research is based on test weighs after the first three days of life (I read a huge pile of original research). So in the early days, I would observe and listen for swallows. Assisting mothers to observe, listen, and feel for swallows can empower her to understand her own babies cues. (In fact, the noise that is commonly heard is actually the exhalation after the swallow, not the swallow itself). This can be important for breaking the cycle of mothers relying on "time" and "rules" for when to switch their babies from one breast to another. It can break the cycle of using "schedules" as opposed to developing health "routines" based on a mutual understanding of cues and responses. I've always hated the terms "baby-led" and "mother-led" and found a nice article by Beatrice Beebe who does research on attachment theory. Her article was very hard to read, but the essence was that you are dealing with the baby and the mother as individuals and the baby and the mother as an interactive system --- really three systems going on. The baby and the mother may independently act quite differently with other individuals. Only when the mother and baby are out of sync with each other do I use any of my own visual observations about the attachment and even then I will always ask the mother how it feels to her rather than make assumptions about what I think would feel best to her. For that reason, I really don't use any "latch assessment tools" other than the mother's sensations and the baby's behavior. Somehow, I have this feeling that when I retake the exam, I may do much worse than before because I will probably feel compelled to write essays for every exam question. The first time around I had a hard time because I wanted to do that and the next time I probably won't be able to stop myself. Every exception came to mind for all the clinical questions. Best, Susan Burger *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome