About once a year I get a request for breastfeeding help. It's been 11 years since I hung up my La Leche League Leader hat, and although I've maintained my IBCLC credential I don't actually use it very often. Last night I got a text from an acquaintance at church. Her baby wouldn't latch, and a mutual friend had suggested that she contact me.
I suppose if I were a volunteer breastfeeding counselor these days, I would get a ton of requests for help via text. It seems to me like a tricky way to do things, and after a dozen texts I asked this mom if she'd like to get together in person. I went over this morning, timing the visit so the baby would be in the neighborhood of hungry but not starving.
Non-latching babies were always the hardest part of the job when I was offering phone help. Nursing is complicated. Sucking is complicated, swallowing is complicated, and arranging those two tasks around breathing is also complicated. Some babies just can't or won't do it, and you can't make them. But I have learned a lot in the past 11 years about both breastfeeding and mothering, and I had some ideas to share.
One piece of the puzzle was figuring out why the baby might be reluctant. There are lots of possibilities, but I had a hunch that the central issue was flow rate. Another piece of the puzzle was seeing how the mom was holding up. Triple feeding (nursing attempts + pumping + bottle-feeding the expressed milk) is often a nightmarish time suck, and retail pumps are not great for bringing in a milk supply, and exhaustion paired with unrealistic breastfeeding expectations can make the world seem pretty bleak. So I wanted to check in face to face about how she was doing, and the answer seemed to be "reasonably well."
The most exciting change in early breastfeeding management since I was active in LLL is the emphasis on laid-back breastfeeding: stable prone or semi-prone positions that allow babies to take the lead. If you recline the mom and put the baby on her belly with his hands free and his philtrum next to mom's nipple, you will very often see a real improvement in breastfeeding behavior. Too many parenting books are still talking about cradle/cross-cradle/football, but if you have a baby who won't latch, your best bet is to get that baby unswaddled and belly-to-belly with mom.
My recommendation (after making sure this could work for their current family situation) was to offer lots of low-stakes low-stress low-flow opportunities to practice latching. With a baby who's not feeding effectively, there are always three steps to addressing the problem: (1) feed the baby, (2) protect the milk supply, and (3) keep something happening at the breast. I wanted this mom to know what a fantastic job she was doing with steps 1 and 2, and that it was perfectly fine for step 3 to unfold gradually. I left feeling like I should have had a magic bullet up my sleeve (wait, we don't put bullets in our sleeves, do we?), but also acknowledging ruefully to myself that there are no magic bullets.
We texted back and forth a few times over the course of the day, and this evening she sent me a lovely update: the baby who had never latched successfully in the previous 3 weeks had latched 10 times today. There's still plenty of ground to cover, but that's an amazing step forward.
I was thinking about how much better this approach meshes with my general parenting philosophy than the Rapid Arm Movement/nipple sandwich strategy we were using in the late 90s and early 00s. I've written so many words here about the value of autonomy for kids, and it turns out to be a useful strategy for tiny babies as well. You can't compel an effective suck from a newborn any more than you can compel a sincere apology from a 6-year-old, but you can make them both pretty mad in the attempt. Of course you need to rule out genuine barriers to the behavior you're trying to elicit (tongue mobility concerns, neurological issues, milk supply problems, etc.), but a lot of parenting, in my view, is about creating supportive contexts that let kids show you what they can do, and offering them frequent low-stress opportunities to practice.
It's also, now that I'm thinking more about it, about remembering that progress is often slow and uneven for kids, and taking the long view. Slow and uneven progress will still move you forward, and rushing it can create problems of its own. (I strongly suspect, in fact, that someone else's attempt at a quick fix is at the root of some of the problems this dyad is currently facing.)
It is becoming harder to extend autonomy to kids in this climate where parental protectiveness has run amok. It's so well worth it, though.
Recent Comments