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What is a Good Latch?

What a "Good Latch" is...

(And is not!)

A good latch is a mouthful of breast that positions the nipple far back in the baby’s mouth, behind the hard palate. The baby’s face, nose, chin and both cheeks are evenly pressed against the breast. The baby’s cheeks are relaxed, not dimpled. When the baby sucks, their jaw moves from front to back, with a visible wave that starts at the chin and ends at the ear. You feel a rhythmic tugging on your nipple. 

A good latch is comfortable, in the "I could do this all day" kind of way.


A good latch is not sucking on the nipple like a bottle nipple.

While your baby is nursing, watch their cheek. Sucking in and dimpling means that the baby needs better positioning.

Sucking only on the nipple won't provide much milk because breastmilk is not removed by suction, but by ejection which happens with compressing, massaging or 'milking' the breast and nipple together.

You might be suprised to learn that a breast pump doesn't work by sucking out milk. Yes, technically pumps suck, but they also release which causes a different response from your body.

Vacuum stretches, and then releases, your nipple stimulating a release of oxytocin, which signals the smooth breast muscle to contract, ejecting the milk. The diaphragm inside the bottle opens from the pressure of the milk to collect it in the bottle, then closes with the next suction cycle of the pump.

 You may have difficulty ejecting milk when you are in pain, compounding low supply, weight gain and latch issues.

 

Here are some actions that aren't helpful and may cause more harm:

1. Latching and unlatching repeatedly will hurt your nipple and cause bruises, cracks or bleeding. Each time the baby clenches your nipple, it injures it more.

 2. Focusing on whether baby's lips are "flanged" or "not flanged". 

3. Pushing your baby's mouth or jaw open. This action triggers a fight response and your baby clenches their mouth tighter. Nobody likes being forced to have stuff put into their mouth. Your baby has probably already had this experience and is learning each time how to prevent it from happening again.

4. Touching your baby's face, top and back of head. All these touches trigger pushing and turning reflexes which moves baby away from your breast, not toward.

5. Hunching forward. This puts your baby in an unstable position and they will clench your nipple for stability, causing you pain and injury.

 6. Using a Boppy, My Brest Friend or other nursing pillow. These are convenient once you and your baby learn how to nurse, but will get in your way right now.

 

How to get a "Good Latch.”

The easiest way to get a good latch is to lean back into a reclining postion, let the baby find your nipple, self-attach and relax into suckling and swallowing. This is also called 'the breast crawl,' 'biological nurturing' or 'laid back nursing.'

If you have tried that and it isn't working, there are probably some good reasons why. You can come back to it when your baby learns how to breastfeed a little better. 

These instructions work for any nursing hold: Cradle, cross-cradle, football and side-lying.

Help the baby take the nipple in any of the dozen ways you've been shown. If it hurts, brace yourself until, and while, you make these adjustments in positioning and posture. As soon as you and the baby are positioned correctly it will stop hurting, or at least hurt much less. It may take 10 seconds or up to a minute. Each time you feed, good postioning will be more automatic.

1. With your baby attached to your breast, lean back into a reclining or semi-reclining position

2. Roll your baby until you are "belly-to-belly"

3. Pull the baby in close with most of their body pressing into you and your belly

4. Wait for the baby to start suckling. If it hurts, even if it hurts a lot, breathe through the pain until they start to suckle rythmically.

5. While the baby is focused on nursing, start to move the baby's body into alignment. You can make as many of these adjustments as you need for comfort.

  • belly to belly (not belly up)
  • ear, shoulder and hip aligned
  • face pressed in with nose, chin and two cheeks all touching the breast
  • chin level, not tipped or tucked
  • spine straight, not in a side-to side "C"
  • baby's hands on each side of their mouth, holding the breast

Gravity holds the baby in a stable position so your baby can relax. A relaxed baby opens their mouth, drops their lower jaw and allows a mouthful of breast and your nipple to be positioned deeply in their mouth. This eases nipple pain for you.

 

Still not comfortable?

 Check your posture:

  • Leaning back, fully supported by pillows or furniture
  • Shoulders square and level, supported by the chair, bed or couch.
  • Legs parallel, not crossed
  • Feet resting on a footstool, ottoman, bed, pillows, coffee table or floor
  • Arms resting on your belly or pillows

Posture for side-lying:

  • Lie on side with a pillow under your head, behind your butt and between your knees
  • Baby lies on side, belly to belly, facing you. Roll a receving blanket and tuck it behind their back.
  • You will probably need to attach the baby while propped on your elbow, before sliding down onto your pillow

Still not comfortable?

This positioning and postural alignment improves 98% of all latches and reduces pain for most mothers. If it doesn't:

1. It may be something you and your partner are not understanding. Written words are not as clear as coaching. This email address is being protected from spambots. You need JavaScript enabled to view it.

2. It may be that you or your baby have tension, injury or asymmetry strains, like back strain in you or jaw misalignment or tortocollis in your baby, from pregnancy and birth that can be relieved with some physical therapy, osteopathy, chiropratic, cranio-sacral therapy or massage. 

3. There may be physical tethering of the tongue, lip or cheeks (tongue tie) that can be revised with scissoring or lasering by a qualified professional such as a pediatrician, ENT or dentist.

 

Reading articles is a great way to become more educated about breastfeeding. Because nursing your baby is a learned skill, you may find some coaching helpful. Please call or text Donna Bruschi at (845) 750-4402 if you would like additional help with your latch. 

 

Understanding Temper Tantrums

Temper tantrums are a cry for help.

A child is totally overwhelmed and needs support. Unfortunately, few parents received support for their strong feelings as children or learned basic skills for working through a tantrum. The opportunity during a tantrum is to develop an understanding of what the child is experiencing.  Children have their own perspective on any event. A parent’s job is to help them cope with the crushing frustration and disappointment inherent in life.

The life cycle of a tantrum:

The child is trying to say, hear, receive, give, or do a certain thing.  If he is unable to complete the action he may get frustrated and start to show signs of distress. When a parent is  in tune with their  child they will pick up these early cues and help the child complete the action. If the parent misses these early cues, the child will amplify the frustration into crying, yelling, hitting or other obvious demonstrations in an attempt to get help.

In an infant, this might be a fussy baby.  The mother notices her baby squirming and fussing and starts to nurse the baby.  The tantrum is averted.  For a toddler, there might be a staircase that is attracting his attention.  The toddler can’t quite negotiate the stairs and starts to get frustrated. His dad stands behind him and directs his feet until his son is climbing safely. In a school age child, an older brother teases his younger sister, who can’t keep up with his verbal gymnastics.  She starts to yell, their mother steps in between them and affirms that the sister is furious because she is being teased. She holds a safe space and waits until everyone is calm. Then, she deals with the brother’s inappropriate behavior.

When the pre-tantrum cues are missed

The parent can still handle a tantrum with love and support. It can be a challenge to negotiate the strong feelings that come out in a tantrum. Tantrums can trigger the parent’s un-met childhood needs and can result in parents acting like children. When a parent is aware of this phenomenon, she can step back, center herself and resume the appropriate adult role. 

Step by step, here are some things parents can try: 

Stay calm, detached, and nearby--offering support as needed. (as well as protection from sharp edges, siblings, traffic, etc.) the parent may have to physically restrain or remove the child to prevent him from hurting himself and others. If the parent finds herself getting upset, it is better to make sure the child is safe, leave the room and calm down. If this is not possible, she should stop talking and breathe deeply. If this is not possible, she should try again next tantrum. She will handle tantrums better with each attempt.

The parent can reassure the child that she really wants to understand what is wrong. Help him to calm down. Only when he is reasonably calm should the parent continue. If he gets upset again, return to calming techniques.

Ask him what happened, and listen.

Listen for the facts (the situation) and listen for the feeling (the emotion.)

If he can't verbalize it, make suggestions and watch his body language for cues that you are on the right track. It may help for the parent to imagine herself in the child’s place.  Once the parent has identified the trigger, she can help the child to understand it. Common triggers are the inability to do a task or loss of a favorite toy. Other triggers are fears, punishment and separation from the parent. Aggravating factors can be exhaustion, hunger, and loud public places.

Once it seems like the parent has figured out what caused the tantrum, she can help her child to say, hear, receive, give or do what he was unable to pre-tantrum or help him work through his disappointment at not being able to say, hear, give, receive, or do it.

Babies and children have the same feelings as adults.

They want things they can't have and suffer disappointment. They are put in situations where they are scared and can't leave. Life is not perfect; some things in life are necessary and painful. It is the parent’s job to put that suffering into a context the child can understand. Parents can help their children share a negative feeling before it turns into negative behavior. 

It is important for children to learn that all feelings are appropriate and negative behaviors are not. Hitting and scratching are never acceptable and the limit must be set firmly by the parent. While some kids take a lot longer to learn how to do this, they learn because the adults in their life remind them and model this behavior. 

When a parent models great behavior, it is her opportunity to shine as a human being. Her child will learn how to behave like a better human being. Children watch their parents like hawks, mimicking their every action. A conscientious parent will attend first to her own actions and words when she witnesses her child doing something inappropriate. Her calmness will automatically help her child to behave appropriately without punishment or bad feelings.

Originally published in “Blender” La Leche League of New York-East

Are Baby Slings Safe

Are baby slings safe? The short answer is "Yes." Slings have been safely used for thousands of years.

According the the Consumer Products Safety Commission, in the past 18 years, 14 babies have died in slings. 3 of those babies died in the Infantino Sling Rider, which was recalled in 2010. Over 1 million slings from this company were taken off the market. This sling style is a "bag sling" and it is different from a "ring sling". 

This is a picture of the Infantino Sling Rider.
Infantino Sling Rider

 

 

 

 

 

The problem with bag slings is that babies can easily move into unsafe positions.
Unsafe bag sling positions

 

 

 

 

 

 

 

This diagram from the Consumer Products Safety Commission shows how the sling is unsafe for an infant. Babies can slide into postions where there airway collapses or is blocked. They are also in positions where the adult can't see their face or feel them breathing.

They further explain it in this video. Consumer Products Safety Commission video

They do not recommend the use of a sling for infants under 4 months.

There are safe ways to carry a baby in a sling from birth up. Use the following guidelines for safety.

1. Baby's belly is towards the adult.

2. Baby is in the frog position or "M" position with their butt lower than their knees.

3. Baby's head is close enough to kiss

4. Baby's face is visible at all times. 

 

The following video shows how to safely wear a baby in a Sakura Bloom ring sling from birth up.

Proper Infant Positioning in a Baby Sling

How to Have a Great Milk Supply

...even if your breasts are small, even if you have twins, even if you're worried.

The secret to an abundant milk supply is frequent, active feeds. For newborns and even many older babies, this usually means 12-16 feeds in 24 hours. When weight gain is steady, predictable and feedings are easier, it's ok to drop to 8-12 feeds in 24 hours, if your baby is content doing so.

Pay attention to the baby's sucking and behavior.

When babies are rooting or looking hungry, they probably need to breastfeed, even if they don't need to "eat." If you aren't sure, it's fine to offer your breast. You can't overfeed a breastfed baby! We aren't used to breastfed babies and often moms will compare breastfed babies with formula fed babies who typically eat every 3 or 4 hours.

If we remember that a baby's stomach is the size of their fist and that breastmilk is digested easily, it makes sense that they would eat frequently. But why is this important? For one, humans are species that carries its babies. Frequent feeding is easy to accomplish when you carry your baby everywhere you go.

Another reason is that breastfeeding is so much more than food for a baby. It's a source of comfort, connection and soothing. It is a way of feeding that fills all five senses at once and gives both mother and baby a dose of oxytocin, the love hormone.

When we look at other species, it's easier to understand the unique qualities of human milk. 

Cows grow about 1000 pounds in the first year. Their milk is highest in protein because this is the essential nutrient for muscle and bone growth. Whales live in the ocean, which is cold. In order to thrive, they have a thick layer of blubber. Their milk is highest in fat.

Humans develop their brains during the first year. Human milk is full of special sugars that feed brain cells. In addition, constant engagement with the mother means that with every feed, their brain is connecting neural pathways. Breastfeeding means that babies smell, taste, see, hear, and feel their mom. Each sip is not just a sip! It is a brain-bursting experience! 

Don’t wait to feed!

One of the biggest misconceptions I run into is "waiting for breasts to fill up" before you feed your baby. The fastest way to make abundant milk is to keep your breasts empty. Empty breasts signal your body to make milk while full ones tell your body to stop making milk.

It's like being at a buffet. When the serving dishes get low, a waiter keeps bringing new ones. If no one eats anything, the tray just sits there. Your body will continue reabsorbing and producing fresh milk, so, unlike the buffet, the milk is always fresh and ready to eat, but over time, you will make less and less milk. Your baby may show signs of hunger and be less content. Their weight will plateau or drop.

In the early days and months, you will feel your breasts filling and emptying. Between 4 and 6 months, the amount of milk you make between feeds decreases. In other words, you won't feel as full. Your body starts to make most of the milk when the baby sucks, rather than between feeds.

Increasing your milk without pumping or galatagogues

If your baby doesn’t seem hungry, and also, is not gaining or only slowly gaining weight, increase the number of feeds in every day using a "mother led growth spurt." Many babies actually prefer to feed every hour or two all the way through the first year and beyond. A good rule of thumb is if your baby is gaining weight and staying on their curve, 8-12 feeds a day is fine. If they aren’t gaining, or they seem to need more, nurse 12-16 times in 24 hours.

A practice that goes along with this is switching sides frequently. A sleepy baby can suckle gently on one side for an hour and receive little or no measurable milk. If you watch them feeding and switch sides soon after they are done gulping, they will receive more milk with less effort. You may feed on each side several times and notice that each time, their sucking happens in short bursts and then slows down.

If your baby suddenly seems hungry after a few weeks of predictable feeding, follow their cues and feed as much as they want - it's normal and nothing to worry about - it's called "frequency days" or "growth spurts". After a few days of nursing more frequently, you should notice more fullness in your breasts and hear more swallowing when they breastfeed.

Worrying about having enough milk may be the #1 worry of all new mothers! 

Research shows that only 1 to 3% of women should worry about it! The first step, and frequently the shortcut, to a bountiful supply of milk is to offer your baby the breast frequently and encourage your baby to drink as much milk as they can. If you are worried, ask for guidance so that you can be really sure your baby is getting enough milk.

Conventional advice of nursing 10-20 minutes on each side is correct in one way- most babies do nurse about this long - but it does not take into account the QUALITY of the session. Watch the baby - when they are getting milk, you should hear gulping, see the jaw moving. and feel a rhythmic pull on your nipple.

How frequently you feed your baby is always the first benchmark to compare if you feel you need to increase the amount of milk you make.

If you feel anxious, check your baby's weight once a week. Ask to make an appointment at your pediatrician’s office, buy a scale or drop in to New Baby New Paltz any time we are open. We have a scale next to the changing table and a 3 ring notebook if you want to keep a chart.

 

How Much Does a Lactation Consultant Cost?

The answer to this question depends on several factors: 

1.What are the qualifications of the Lactation Consultant?

2. What do you need help with? 

3. Do you have health insurance or low-income qualifications?

Because "Lactation Consultant" is not a professional license recognized by the New York State Board of Regents, there is no Lactation Consultant license in New York (or most states), which means that anyone can say they are a Lactation Consultant. Most Lactation Consultants get a certificate from an organization showing their level of training, but there is no requirement that they do so.

So, it's a good idea to interview several Lactation Consultants before you select one and these questions can help you know which one can help you best.

  1. What is your certification?
  2. What is your professional training in helping moms and babies?
  3. Where have you worked as a Lactation Consultant?
  4. How long have you been a Lactation Consultant?
  5. Do you have a specialty?
  6. Describe your situation and ask, "How would help me in overcoming this problem?"
  7. How many appointments should I expect if we work together?
  8. When are you available to meet?
  9. Are you able to come to my home?
  10. What is your fee?
  11. Do you accept insurance?
  12. What resources do you have available to support me and my baby after our appointment?

International Board Certified Lactation Consultants (IBCLC) are the highest level of Lactation Consultants. In order to be certified, IBCLCs must pass certain college level classes, use a mentor who supervises their clinical training and pass a rigorous test. In addition, they must re-certify every 5 years and take 15 hours of continuing education in breastfeeding every year. Among IBCLCs there are specialties and wide differences in experience. IBCLCs who work in the hospital tend to work more with beginning breastfeeding, the first few weeks and breastfeeding premature babies. IBCLCs in private practice generally see the full range of breastfeeding experience from birth to weaning. In addition, they are free from corporate politics and policy.

Services by IBCLCs are covered by insurance companies both in and out of network. Coverage varies. Some IBCLCs are in network and you pay only a deductible. Most private practice IBCLCs are not in network. You pay out of pocket and be reimbursed. Most accept credit cards. Some offer sliding scale or payment plans. You can expect to pay IBCLCs from $0 in a hospital to $300+.

 

Certified Breastfeeding Counselors (CBC) are RNs who take a 45 hour course and pass the CBC certifying test. You can expect CBCs to charge from $0 at the hospital to $300+ for a home visit. Services of CBC/RNs are covered by insurance companies both in and out of network. Coverage varies. Some are in network and you pay only a deductible. 

 

Certified Breastfeeding Specialist (CBS), and Certified Lactation Counselors (CLC). These certificates are awarded after 45 hours of classroom education. Neither of these certifications requires any supervised training or personal experience before the Lactation Consultant receives their certificate. There is a wide range of experience and knowledge in these designations, from those who take only the 45 hours of classroom education, to RNs and MDs who earn the certificate to better understand breastfeeding. You could expect a consult to cost between $0 for CLCs working in a hospital or medical office, those just starting in private practice, up to $75 for a one-on-one appointment.

 

WIC Breastfeeding Peer Counselor: WIC PCs receive supervised training through WIC. There is a wide range of experience and knowledge in Peer Counselors, from those who have taken 20 hours of classroom education to those who have worked for WIC for decades. The services of WIC PCs are free if you receive WIC. In addition, some WIC offices have CLCs and IBCLCs on staff who are able to see you for a one-on-one appointment.

 

La Leche League Leaders. Technically, a LLL Leader is not a Lactation Consultant, but a highly educated volunteer who has breastfed at least one baby, gone through extensive training and mentorship and agrees to LLL's Ten Concepts of breastfeeding and parenting.  Breastfeeding help received through La Leche League Leaders is free. Yearly membership is encouraged but not mandatory. La Leche League Leaders help women either over the phone or in monthly group meetings that are held all over the world. They are allowed to make home visits, but not obligated.

 

Which is the right one to make an appointment with?

 

All Lactation Consultants and Specialists can help you with this:

  • How often to feed and how much
  • What to expect in the early days
  • Baby's feeding cues
  • How to know baby is getting enough
  • How to make more or less milk
  • How to have optimal feeds
  • Suggestions about latch
  • Show you different ways to hold your baby
  • Explain nipple care
  • If you want to pump, they can help you size pump flanges

All Lactation Consultants will observe you and your baby breastfeeding and write out a care plan that focuses on your problems and solutions.

 

An IBCLC is a health professional who, in addition to the basics above, will take a thorough medical history and discuss things that have an effect on breastfeeding. They work with your doctor or midwife if you need blood tests or other medical procedures that impact breastfeeding or milk production. 

 

If you have one of these situations, an IBCLC will probably be more helpful:

  • Your nipples are raw, bleeding, cracked, or hurting
  • You think, or have been told, that you are not making enough milk
  • Your baby is 5 days old and your milk has not come in or is 10 days and has not regained birth weight
  • Your baby is colicky or fussy or you think that your baby hates you and/or breastfeeding
  • You are crying every time you breastfeed because it hurts
  • You can't pump the amount of milk you need
  • You have an ongoing medical condition
  • Concerns about your baby's weight and how they latch or breastfeed,

In these situations, an IBCLC in private practice is more likely to be of help:

  • You need ongoing support and knowledge - continuous care
  • You need a long (hour plus) appointment
  • Your baby is older than 2 weeks
  • You need a specialist in your problem
  • You don't want to go to a hospital or clinic
  • You think, or you are ready to quit breastfeeding because you have tried everything
  • You want information unfiltered by corporate practice, policy or politics
  • It is an evening, weekend or holiday and your baby is hungry

With this information, where can you find a Lactation Consultant?

Most hospitals, WIC offices, and some pediatrician's offices and breastfeeding groups have Lactation Consultants on staff. 

There are many Lactation Consultants in private practice. You can find a geographical listing here: http://www.ilca.org/why-ibclc/falc 

Ask your friends or your doctor for a referral. You can also search online using search terms like "lactation consultant" along with the name of your town or nearby city.

When you are researching, it may seem that using a free or low cost Lactation Consultant is the best way to start. Another way of thinking is that if you never breastfed before, an excellent Lactation Consultant will shorten your learning curve and prevent problems. This is why it's important to talk to several before you make your decision. Remember that the most important thing is that you feel comfortable and overcome your current challenges.