Booby Traps Series: “They said the latch was fine.”

This is the 27th in a series on Booby Traps, made possible by the generous support of Motherlove Herbal Company.

There are few topics that get me going more than the quality of help mothers get in the hospital getting their babies latched on comfortably and effectively.  So I hope you’ll forgive the frustration you’ll hear in this post.

Why do I get worked up about this?  Because CDC data show that one in three mothers who stop breastfeeding in the first month do so because “breastfeeding is too painful.”  37% percent of moms who stop in the first month report, “sore, cracked, or bleeding nipples.”  And because a good latch results in good milk transfer and the development of a full milk supply, and 50% of mothers report early weaning because “breastmilk alone didn’t satisfy my baby,” and another 50% report “I didn’t have enough milk.”

But most of all, I get upset because all of this could so easily be avoided.  When I hear mothers who have left the hospital with sore and bleeding nipples, say “they said the latch was fine” (an assessment made, in one case, from the doorway), I know that in the vast majority of cases their pain was avoidable.

Of course, not all pain with breastfeeding is a result of a poor latch.  Things like tongue ties, milk blisters, and thrush certainly cause pain.  But the vast majority of mothers I’ve seen who have left the hospital with pain have babies who are simply not latching on deeply.

For moms with ‘run of the mill’ latch problems, some good help can usually make breastfeeding significantly more comfortable in a matter of minutes.  In other words, it can go from “I’ve been crying through feedings,” or “This hurts more than labor did,” to “Oh my God, so this is what it’s supposed to feel like?” almost instantaneously.  How do I know?  Because I’ve helped moms get from here to there over, and over, and over.

Though I try not to show it, when moms thank me for helping them with the latch, I feel less gratified than angry.  I feel angry that the simple adjustments I made weren’t taught from the beginning.  I feel angry because, for many moms, this goes beyond “breastfeeding duration.”  It means that the early days of motherhood – a precious, irreplaceable time – are filled with pain, frustration, and doubt.  Most of all, I feel angry that all of that could be so easily avoided.

Is it too harsh a statement to say that moms are being robbed?  Robbed of peaceful early days with a new baby?  Robbed of good memories?  Robbed of the chance to fulfill their breastfeeding hopes and meet their goals?

I’ve thought a lot about the causes of this poor help, and here’s my list of contributing factors:

Poor training. As I’ve written before, preservice training for nurses, doctors, and other providers is generally cursory at best, and once on the job inservice training is not consistently done.  So some of the staff at hospitals just don’t know how help moms with latch.  And some dispense inaccurate information (i.e. “Your nipples with toughen up”).

Workload or low priority? Nurses, doctors, and other hospital staff are busy, and getting busier.  Helping with breastfeeding can take a while.  I’m sympathetic to the nurse who is running her behind off to keep up with her patients.  But I also know that organizations can make time for things they consider important.  So, what does it say about a hospital’s priorities that mothers are permitted to leave the hospital in such pain?

Changes in practice. To some extent, the target has been a moving one when it comes to teaching about latch and positioning.  Until maybe ten years ago, the state of the art advice on how to get a baby latched on was “line up the nipple with the baby’s mouth and ram her on she opens her mouth.”  Then research and clinical practice started to support the “asymmetrical latch,” in which the baby is lined up “nose to nipple” and the chin is touched to the underside of the breast, eliciting a wide gape (see this video for the best illustration).  When latched on this way, it looks like the baby has more of the breast in the chin side of the mouth than the nose side.  Newer research is supporting the use of reclined positions (“laid-back breastfeeding,” or “Biological Nurturing”) to elicit babies’ innate feeding instincts and ability to latch deeply.  At this point I think that hospital staff can be forgiven for not knowing about this latest trend, since the research is still fairly new.  But I would hope that in the next few years that will change.  For now, if you encounter a nurse who hasn’t heard the phrase “asymmetrical latch,” move on.

Deferring to lactation consultants.  I think I’m seeing a trend toward viewing basic breastfeeding support as the job of lactation consultants, rather than the job of the nurse.  It’s wonderful that more hospitals are employing lactation consultants, but unless a hospital intends for them to see every mother (and this is not common), it appropriately remains the job of nurses and others to get mothers going with breastfeeding, barring anything complicated.  I worry that mothers who just need basic help getting a good latch end up waiting to see a lactation consultant, who is appropriately busy with more complicated situations (prematurity, tongue tie, breast surgeries, and twins are a few that come to mind).  Meanwhile, many moms whose problems could be solved quite easily, wait for the cavalry which never comes.

Did you get good help with your baby’s latch when you were in the hospital?  Why do you think moms often get poor help with latch in hospitals?



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14 Comments | Last revised on 12/14/2011


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14 Responses to Booby Traps Series: “They said the latch was fine.”

  1. Skyfire says:

    I had an awesome lactation consultant show up in my room right when my baby was born. She was matter-of-fact, sympathetic, respectful, gentle, and a bunch of other things that all doctors and nurses ought to be. The latch she helped me achieve in that time, on the left, was perfect, and the left side never caused me pain. The right side didn’t get that sort of attention, and it ended up so painful, cracked and bleeding.

    The I saw a really great nurse at night, who was encouraging. The other nurses could only remark on how my body proportions made it harder to breastfeed, not give me tips on how to work around them.

    Fortunately, this awesome LC made a follow-up call to me and asked me to come in to see her at her office, and helped me correct the latch on the right, and told me about a weekly support group she led. She said that the services are there, at least in our area, but many women don’t know about them, or knowing about them don’t think that they will help, or don’t think they can afford them. My state healthcare paid for mine, and the awesome LC told me that she never refused a woman who needed help for lack of ability to pay.

  2. Sarah S says:

    I didn’t get great help with latch in the hospital. I saw some lactation “specialists”, but all I heard from them and the nurses was to just shove my nipple in his mouth. When I told my nurse my nipples were cracked and bleeding she said, “welcome to motherhood” and one of the lactation specialists gave me a nipple shield – which helped, but didn’t fix the problem.

    Everyone missed the fact that my son was tongue-tied. He had a terrible latch and didn’t want to open wide. I should have gone to see a lactation consultant but I had done so much reading up on breastfeeding that I thought I knew everything and that everyone was lying when they said a proper latch shouldn’t hurt. The nurses told me my latch was fine but I was still in lots of pain so I thought the “proper latch shouldn’t hurt” doctrine was a lie. I also thought the “baby is more efficient than a pump” advice was a lie too, because until I found out about tongue tie, that was the case. I think if I had just sucked up the IBCLC fee and gone and gotten the tongue tie thing figured out I could have made four months of breastfeeding so much better, and used way less formula.

    Sorry for the rant, but I got less than stellar info in the hospital. Next time if we are having problems I’m going to make an appointment with an IBCLC right away. Oh, and I’m checking for tongue tie with #2 while I’m still in the hospital.

  3. Laurie says:

    I see 2 sides of this.

    #1: When I was a first time Mom, I had an AWESOME LC who saved my BF relationship with my son. THe nurses really werent helpful, but she was great. We made it 14.5 months.

    With my daughter, I knew what I was doing, but something was wrong. I was at a different hospital, and asked to see an LC. The one who came told me I was holding her wrong and spent about 20 minutes underlining some stupid crap in a preprinted hospital “breastfeeding your new baby” pamphlet, then left. She came back the next day and claimed that she’d never seen me before. I was bleeding by the time I got home, then called a good friend who is an IBCLC, and got my daughter’s tongue-tie diagnosed and (finally) treated. She’s now 13 weeks old and doing well.

    #2: I am a pediatrician. To say that we get any breastfeeding education at all is almost a fallacy. I knew NOTHING about it until I had my son, and didnt learn about the issues tongue tie can cause until I had my daughter. Now I go out of my way to help moms latch correctly inthe hospital and in my office. Im networking with the local IBCLCs and attending a BFing moms group as well. It frightens me how unbreastfeeding friendly even my partners are. It’s SUCH a huge issue for so many moms.

    I completely agree that nurses in the hospital should be trained to actually help. And if someone is being hailed as a “lactation consultant” they’d damn well better be an IBCLC.

  4. Youch. These stories of not-enough-of-the-right-support make me cringe, as an IBCLC who works in a hospital and has a home-visiting private practice. Sore, disappointed and discouraged moms need competent and compassionate support!

    This article http://tinyurl.com/d6778w7 from Drs. Brenner and Buescher is right on target: Breastfeeding *is* a clinical imperative, and everyone from healthcare providers to family members to employers can help mothers avoid booby traps with the right support.

  5. Kimberly says:

    When I had my second baby, I asked to see an LC. She came in. I said “yea…I just wanna make sure I’m doing this right…I stopped BFing my first daughter around 3 months and it’s been a really long time since I’ve nursed, so I just wanna make sure I’m doing this right.”

    She took my breast and shoved it into my daughters mouth, lurching me forward. “There, that’s how it needs to be done” so said. She sat there for a minute or two while my daughter nursed, then promptly left. I never saw her again.

    Thankfully, I corrected THAT problem, because I had been reading up on it myself. And to be honest, I was nursing my daughter just perfectly before I saw the LC…I just wanted some support from a “professional”. I learned my lesson. I don’t trust “lactation consultants” in the hospital where I will be delivering my third child anymore. I seemed to know more about breastfeeding than they did. It’s also given me a good sense of where I want to go in the terms of continuing my child/birth education (I’m currently a labor doula).

  6. Connie in NC says:

    The LCs from our hospital’s Womens Center were great! I took the BFing classes, and to LOOK at my son’s latch he looked like a pro. But when one of the LCs came to do their daily rounds the next morning, FIRST thing she did was check with her pinky finger how far he would accept it, and he didn’t! He gagged bigtime. She educated me further on how he needed to ‘practice’ on my pinky in between feedings to begin to accept it further and further. That said, she sent me home with a nipple shield that caused more problems than it fixed, but she was WAY more insightful than the nurses. I’m SO very thankful for that LCs visit (and her follow-up the next day) to make sure that I was on the road to a good, deep latch before letting me out of that hospital THINKING I had a good latch!

  7. Emily says:

    The first midwife on the post natal ward tried to ram my son onto my nipple, failed so reached for formula without my consent. My exhausted protest led her to halve the amount she gave. I then never had a moment of help until a lactation consultant came in 36 hours later. I was sent home without my son latching AT ALL, despite the fact my milk came in very quickly. I then got told by the home visit midwife I had 12 hours to get my son to gain some weight before he would be re-hospitalised. The lactation consultant the next day told me I was starving my baby. So no. I got no help in hospital. And this is a so-called baby friendly hospital. I spent the next 11 weeks working so hard to get breastfeeding happening. I was so pig-headed about it I wouldn’t give up, but I can completely understand poor latch, bleeding cracked nipples, cracks not healing, nipple thrush, low supply etc etc would deter many. Looking back, I wish I had said to that midwife at home “sure, put us back in hospital, will I then get the help I needed from the beginning?”

    The story has a happy ending that we are still happily breastfeeding at 15 months :)

  8. Kelly says:

    While in the hospital, I asked two nurses to help me, and saw two different lactation consultants. The nurses were definitely less helpful than the LCs – “yep, he’s on there” was about the most helpful advice that I got, even though it REALLY hurt (only for about the first 30 seconds, but it was pretty bad). The LCs were much more helpful, and did assist with latching so that it was more comfortable, and got me headed in the right direction. Still, I couldn’t achieve it without their help – I just didn’t have enough hands (and my SO’s hands were big and fumbly, so when he tried to help, it really just made things more confused, unfortunately). In hindsight, I should have called LLL or somewhere after we got home – I slogged through and it took weeks to get more proficient, and then it took a few more weeks for everything to heal and for me to be comfortable with breastfeeding (and now I actually look forward to it, go figure!)

    I can definitely see how a lot of women in my shoes would have stopped after a few weeks, I just didn’t consider that as an option.

    That said I still don’t think we have the most efficient latch (at almost 11 weeks) but it’s getting harder and harder to change how he does things now, especially since I am back at work and he’s getting most of his milk via bottle now. :(

    If there’s ever a next time, I would definitely get more immediate help after getting home – the LCs in the hospital were good, but they had limited time and had to check on lots of mothers, so I didn’t really get comprehensive help as they were in and out so quickly.

  9. Valerie Longfellow says:

    I am a nurse who works L&D, nursery and post partum, so I have an opportunity to see moms and babies during the entire course of their stay in the hospital. I breastfed my own 3 children well past their first birthdays, while working 12 hr. shifts, pumping, through mastitis, nursing strikes etc.

    Nothing frustrates me more than spending a lot of time with a mom to get her baby latch properly to have her attention diverted by an incoming text message or facebook notification. Where I work, I don’t see a lot of commitment to getting it right in the early days, because moms feel pressured to spend time with visitors (who stay too long or don’t recognize a mom might be shy about breast feeding in front of them and is too polite to kick them out.)

    I always tell “my” moms, “the next time your baby is hungry, hit your call bell so I can come in to see how it’s going. SOmetimes just a little adjustment can make a huge difference and you can go home less nervous about feeding your baby.” Most people never do it. Then, when we do our follow up calls, we find out they’ve given up in the first 2 wks.

    So I’m asking you, new moms, what more can I do? Or what can I do better? 25 yrs. on the job and never get tired of trying to get better. :-)

  10. Cheryl says:

    Your article is spot on. I get the exact same comments from the nurses at the hospital: “Your latch is correct” (but I said its painful) “its normal for first timer, your nipples will toughen up”. Unfortunately, they do not have an LC in the hospital I’m at. Still having doubts, I asked every nurse that came by whether I’m doing it right. Every single one of them looked and told me its correct when they see my baby’s chin buried in my breast, and complimented he suckle well. None of them checked his lower lips, and by the 2nd week, I only realized its an incorrect latch. He has been curling his lower lips and not opening wide.

    Baby is now 3 weeks and has picked up quite a number of bad habits (sleeping just 10 minutes into the feeding, using it as pacifier, etc.) And because I wanted my nipples to heal for better breastfeeding, I expressed and used the bottle so many times in a day. Now when I put him back on the breast, the latching is even more painful than before. He seemed to be chewing and tugging at the nipple.

    I engaged an experienced midwife who managed to latch my baby on correctly and trigger an immediate letdown for baby. Spent less than 30 minutes showing me how to latch correctly, but baby was sleepy so we didn’t get a lot of practice. She advised me to stop bottles immediately. Then she left, and when I tried it myself, I never got it right. Re-latching baby will make it worse as he gets frustrated at me having him to seek for the nipple again and again. And stopping the bottle abruptly was a mistake, baby never got enough from my breast, he’s always hungry and I’m hurting badly. I’m back to using bottles but my express milk deteriorated after just one evening of exclusive breastfeeding my baby who could not suckle efficiently.

    Am going to see a LC in a few days, and I really do hope this can be corrected soonest possible.

  11. Erin says:

    We had a terrible time with nursing at the hospital, and all the nurses, doctors, and even the lactation consultants that visited said the latch was fine. They told me that my fair skin meant my nipples would crack and bleed. One lactation consultant came in and told me I was doing it all wrong. She was very frustrated, and since I was breastfeeding at the time, decided to take matters into her own hands – literally. She grabbed my daughter’s head and jammed it on my breast. My daughter started screaming and weeping as she repeatedly forced her mouth onto my breast. She kept saying the open mouth from her crying would promote a good latch. I finally told her to stop because I was crying along with my baby. I felt humiliated and she promptly left. In some ways it was better to be told it was just supposed to hurt by the nurses.

    After I left the hospital, I spent every feeding almost screaming in pain, which terrified my husband. I developed mastitis in both breasts due to the severity of the cracking and bleeding. I almost gave up, but then made an appointment with a different consultant. She sat down with me and my baby for 20 minutes, assessed my nipples, looked at her latch, checked her tongue, checked her lips during nursing. She helped me achieve the asymmetrical position on the nipple by using the football and reclining holds (both which were much better with my c-section and large breasts). She invited me to a new moms group, gave me her card and home number, got me new nipple cream (I’m allergic to lanolin), and gave me some nipple shells to help air movement for them to heal. I treated the mastitis and subsequently successfully enjoyed nursing bliss! We are a champion pair now at 2 months!

  12. Jessica says:

    My initial experience with breastfeeding was terrible. After my son was born the lactation consultant came to the delivery room and got him latched on for me. Then the next few times I fed him I was alone. I immediately got angry red blisters on my nipples, and I knew something was wrong. I called the hospital lactation consultants to fix the latch, which they did temporarily by placing him on my breast and showing me what to look for to confirm he had a good latch. The nurses were trained in lactation as well, but had many other duties to perform and couldn’t dedicate the proper time to help us get the latch correct. I spent the rest of the time in the hospital attempting to replicate what they showed me, and I just couldn’t do it while trying to juggle a wiggling newborn with his hands always in his face. I went home with two vicious open wounds where my nipples were, and for nearly two weeks I screamed and cried every time my child ate. I changed the hold from cross-cradle to football, and that helped some, but the wounds weren’t healing.

    I thought maybe this was how it was supposed to be, because every single person in the hospital lamented that I had fair skin and warned me it would be toe-curling until my nipples toughened up.

    I saw a lactation consultant two weeks later who confirmed that his latch was fine and commended me for continuing to breastfeed through the pain. She recommended I give him a bottle of expressed milk for a few days to give my nipples time to heal, which I did (and they didn’t), then I saw my midwife for my first postpartum checkup. She noticed my son had a lip tie, which limited him from opening his mouth and achieving a deep enough latch. It looked textbook perfect from the outside, but in reality he didn’t have enough nipple and areola in his mouth. I had an ENT snip his lip tie and immediately noticed the difference. And with the help of Dr. Newman’s all-purpose nipple cream I am healed and breastfeeding virtually pain free just one month later.

    My advice is to never give up, even when you’d rather go through labor all over again than breastfeed. Get help to get it right, because once you do, you wouldn’t trade the time you spend breastfeeding for anything.

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