Living in NYC, there are many opportunities to interact with celebrities.   However, one of the reasons John Lennon loved it here is that, for the most part, his privacy was respected.   

I stood on line behind Kevin Bacon at my Starbucks.   I could feel my father desperately channelling through me an urge to engage him in conversation.   Although I inherited my dad’s ”gift of the gab,” I could not utter this joke forming in my mind.  “So, this is what they mean by six degrees of separation?”   If only I had remembered at that moment that his wife Kyra had breastfed.   Given my penchant for marketing at Starbucks , who knows what I might have been able to say. 

All kidding aside,  I have found that there is less than 6 degrees of  separation for breastfeeding success.  

• Your mother, partner, a sibling or close friend, doctor (pediatrician or obstetrician), lactation specialist can all impact your choices and the trajectory of your experience. 

Six Degrees of Separation For BF Success

One of the most important considerations is surrounding yourself with positive breastfeeding role models and enthusiasts.   Given the barrage of hormones, any lack of support, whether real or imagined, can shake your confidence.  Those who love you do not want to see you exhausted and overwhelmed.  They may try to relieve you by offering to give a bottle or encourage you to consider an exit strategy. 

Breastfeeding is natural, but it is also a learned skill for both mother and baby.   Tensions can build when couples are not on the same page about this essential aspect of caring for their newborn.  Attend a breastfeeding class together if at all possible.   Remember that coaching does not end after labor.  

Many of you will defer to the “authority figures” such as the doctor and lactation consultant.  

1. No Pediatrician will hang out a shingle saying they are opposed to breastfeeding.  However, early supplementation with formula is a big clue about their knowledge and support of breastfeeding. 
2. A survey of Pediatricians published in late 2008 verifies that their promotion of breastfeeding is down.
3. Lactation consultants that rely too heavily upon gadgets and pumping may further overwhelm a mother. 
4. Check out your local parenting boards and read them carefully.  Look for someone who has the clinical expertise to fix your latch rather than manage your pumping.
5. Ask your friends to  honestly share their breastfeeding experience and judge if you want some of the same.
6. Follow me on twitter or become a member of  The Breastfeeding Salon

We live in an interesting period of human history where popularity and affiliation are highly valued.   With some preparation you can assemble your dream team of breastfeeding support within six degrees of separation.

Mothers are literally buying into the idea that pumping is the magic ticket for breastfeeding success.   Thanks to the ‘pump pushers’  it is a rare woman who actually believes that she can only breastfeed.  I have written about this “Pump Mania” extensively in  Are You All Pumped Up? 

Many lactation consultants and health professionals are encouraging a dependence upon pumping.  They have been sold on the notion that the pump is as good, if not better than a baby feeding directly from the breast.   They tell mothers, “Pump to see how much milk you are making.”  Another common piece of advice is “Pump after every feeding to increase your milk supply.” 

Clinical evidence shows that pumping is always second best when compared to direct breastfeeding with an excellent latch.   What is obtained from pumping is only a percentage of what the baby can get when properly positioned on the breast.  

The impression of increasing the milk supply often comes from the fact that the breast seems fuller with the combination of breastfeeding and pumping.  Assessing the quality of breastfeeding is essential because the appearance of fullness can be misleading. 

• If the baby has a poor latch and the mother is relying more heavily on the pump for removal of her milk, the breast will build up its storage capacity. 
• An excellent latch leads to a breast in equilibrium rather than having a leaky, full and uncomfortable breast.

Pumping most definitely has a place in the breastfeeding experience of some, but not all, new mothers.  Those mothers who encounter challenges due to prematurity, maternal/infant illness or those who work outside the home, will most likely need to pump if they are to  maintain their milk supply.  

It is both ironic and disturbing that such a profound lack of confidence in milk supply by mothers has grown in an environment where there are legions of lactation consultants and breastfeeding advocates now among us.   It turns out that the allied health profession of lactation consulting (IBCLC) and Medela, the leading manufacturer of pumps world-wide, have been closely linked throughout the past 25 years.  (I don’t seem to be alone in voicing my concerns.) Read more here.

• A rise in individual pump ownership and use since the mid-1990’s is directly proportional to this increased focus on breast milk supply versus direct breastfeeding.  

 As far as I can tell,  mothers do not lose sleep worrying about how many ounces of amniotic fluid their placenta is making for their babies.  They trust in the wisdom of their bodies to manufacture what is needed to get the job done.   Before the advent of routine sonograms, “the bag of waters” was not even on the radar until time for labor.

Breasts would be see-through or come with alarm systems if the volume was the critical factor to be considered.  The notion of volume  being important comes from a formula feeding model-nothing changes in that processed food save for calories delivered by the ounce.

This collective obsession, pun intended, with proving how much breast milk we have, makes me think of the biblical figure, Doubting Thomas.  

Why do we need to see our milk  in order to believe in the ability of breastfeeding to nurture our babies?

Human breasts and nipples come in different shapes and sizes. The function of the mammary glands remains a constant, but their form has great variability. It is a modern paradox that the visuals often stop breastfeeding success in its tracks.

Never before in human history has there been such a lack of faith in the packaging and delivery system of direct breastfeeding. 

Nipple Shield  

Nipple Shields are fake silicone nipples which a mother can use over her own nipple. These nipple “condoms” are intended to protect the mother’s nipples. In some instances, they are used if the nipples are less prominent or inverted to get the baby onto the breasts.   

The problem with shields is that they are huge and get dirty; they can complicate the latch issues by not helping the baby to learn to latch directly onto its mother’s breast.  They have been associated with low milk supply. The baby using the shield with a shallow latch gets a diminished amount out of the breasts and over time this has a negative impact not only on intake, but on overall milk production.  In addition, this poor latch can cause bruising beneath the areola and increased intake of air by the baby.

SNS

Gadgets such as tube feeding systems (SNS)  have gone in and out of fashion over the past 20 years.  They can interfere with getting a proper latch. When the system is used at the breast, babies can learn to by-pass a deep latch, opting instead to sip while hanging out on the tubes and their mother’s nipples. 

A mother can experience a sense of redundancy, guilt, overwhelm and increasing nipple soreness when using the SNS. She is breastfeeding and pumping, often supplementing with formula; her focus is on ensuring intake of measurable volumes rather than perfecting her latch.

There are instances where the use of both Nipple Shields or the SNS may be appropriate. However, these tools were never meant to be the first line of defense. They were intended to be a bridge to success while the fundamentals of latch and Conscious Breastfeeding connections are optimized.

Beware of these nipple add-ons. They will have an impact on the quality and duration of your breastfeeding experience.

I found multiple references that led back to this  photo guide  for proper latching technique.   I will address the accompanying directions in the next post.  

What is wrong with this picture? 

Plenty.  I’ll list a few of the issues.  There are limits to any two-dimensional portrayal of a baby latching onto a breast. You are literally getting only snapshots of an activity which often looks similar to the untrained eye. 

Frame 1

Looks like the baby here in Frame 1 is taking the breast as if it were a bottle.    

• It should be noted that most people would not point a bottle nipple down into a baby’s mouth as it would cause him/her to gag.  They may go in centered, but immediately aim the artificial nipple toward the palate. 

• This is one of the most common mistakes made by new mothers initiating breastfeeding.  They aim the breast as if it were a bottle and end up putting their nipple on their baby’s tongue. 

The mother’s posture is unclear throughout this photo essay.  

Frame 1 looks like she is upright and in frames 2-4, it looks like she could be lying on her back or side.  Is it even the same baby in all of these shots?  The first baby looks different from frames 2-4. 

Frame 2

Frame 3

Frame 4

The impression is that the nipple should be centered in the baby’s mouth for latch-on.  

• If it is done this way the nipple will be captured by the tongue and gums causing pain and trauma. (Frame 2 & 3)

• The breast should be stabilized during the latch.  Nose, not mouth opposite the mother’s nipple.   Move the baby, not the breast.
  

The angles of the baby to the mother’s body are all wrong. 

• The nose is in deeper than the chin. The baby is barely past the nipple. (Frames 2-4)

• Baby should not be parallel to the  mothers body, but rather at a 10-15 degree angle to the plane of her body.

 A well-positioned baby should be tucked in very close to the mother’s body.

• The chin should be deeply planted on the cleavage side of the breast around ~7 o’clock; the top lip would be around ~1 o’clock. This deep mouth position would tip the nipple up into the palate and there would be no contact with the tongue.

• The lips would automatically evert or fan out if these angles were corrected. You cannot see the phlanging of a newborn’s lips if there is a good latch. (Frame 2, 3, & 4)

The saying goes…A picture is worth a thousand words.   However, a latch photo series is never as simple as it looks and much can get lost in translation. 

As a conscious breastfeeding coach, I remind you that it is all about perspective.  Ideally, a breastfeeding latch taught  through the eyes of the mother and evaluated by the sensation of her nipples.

To spare nipples pain and trauma during breastfeeding, it is essential that we re-examine our view of the latch. We must keep in mind that it is Breastfeeding and not Nipplefeeding!

The human nipple is comprised of responsive, erectile tissue which carries messages to the brain. However, unlike other body parts with such traits, it does not lengthen that dramatically if there is a great latch during breastfeeding.

The nipple should never be the focus of attention. It is just the exit through which the milk fl0ws.

During breastfeeding, it should be the bottom of the breast, rather than the edge of the nipple/areola, which is actually on top of the baby’s tongue. This is described in some circles as a “sandwich” of breast tissue which needs to be deep in the babies mouth.

I am happy to report that there are thousands of breastfeeding pictures now posted on the internet. You would think that they might add some dimension to the teaching toolbox. However, there is a big difference between an artistic shot of breastfeeding such as this, by Marga Serrano,

FOOD TIME!!

and one that is instructional for a new mom with sore nipples!

Many of the photos that I found depicted babies that are clearly older, experienced breastfeeders. It would be fair to assume that sore nipples would no longer be an issue for their mothers.

Those shots that portrayed newborn babies were vague at best. Varying latches were seen from different angles; the details of each latch were unclear. Most of these breastfeeding photos were understandably focused on the baby and gave no clue as to the mother’s experience of the latch.

Unfortunately, the conventional wisdom is that the baby knows what it is doing and that an attachment of any sort is acceptable. Most people, health care workers, family members and the mothers themselves, believe if it looks like breastfeeding, then it is breastfeeding.

I beg to differ. Breastfeeding should be evaluated by how it feels and how well it works, rather than merely upon how it looks.

Please share your points of view.