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

by Tanya Lieberman, IBCLC | December 14, 2011 2:57 pm

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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