A Widely Ignored Shift in Breastfeeding

As a followup to the recent post on breast compression, I would like to point out that how a baby latches on, is also very important to increasing the breastmilk intake by the baby.

 

There is a shift in breastfeeding that should have occurred a long time ago. A shift to the asymmetric. An asymmetric latch. Knowing how to achieve an asymmetric latch is crucial to helping mothers with breastfeeding and increasing the breastmilk intake by the baby. Showing mothers what an asymmetric latch looks like is one of the first things we do at our clinic when helping mothers with breastfeeding. Together with breast compression, it is a foundation for everything else we do.

 

Why does it make a difference? The deeper (or better) the baby’s latch on the breast, the better; better, from the point of view of mother’s having pain or not, and how well the baby gets breastmilk. Pain during breastfeeding is a sign the mother needs help; so if breastfeeding hurts, almost always, the baby´s latch is not as good as it could be. Even Candida (“thrush”, “yeast”) infections are due to an underlying problem, since Candida does not grow on normal skin; the damage of the skin from a poor latch comes first and needs to be fixed if we are to provide a permanent solution to Candida or nipple pain of any kind. As well, the better the latch, the more breastmilk the baby will get from the breast.

 

The experience of my time in Africa provided me with an interesting insight: one of the things I noticed back many years ago was that the mothers were often latching the baby on with what I would consider a poor latch. I discussed this with the person in charge of teaching for the Baby Friendly Hospital Initiative, wondering why, if it were so important, as I believed then as did she, why mothers we were seeing had babies with really poor latches and yet neither the mother nor the baby had problems with breastfeeding. True, sore nipples, even there, were considered “normal”. I pointed out to her that we were seeing many mothers breastfeeding without problems of poor weight gain in the babies despite what I (and she) would have considered a poor latch. I didn’t anticipate her answer: “Yes, quite right, but the mothers in this area are said to have their milk drying up very early, usually within the first 4 months”.

 

And we see this problem in Toronto as well. Mothers who started off with an abundant milk supply, around 3 or 4 months after birth have babies who start acting as if they are not getting fast enough flow of breastmilk. They pull at the breast, they are fussy at the breast and between feedings, they are frequently sucking their fingers much of the time, and they may even refuse to take the breast, especially during the day. And all this may occur despite the baby breastfeeding exclusively and even gaining weight well. Which makes it difficult for the mothers to believe their milk supply has decreased – this decrease being relative to the copious milk supply the mother had in the beginning.

 

Because of continued good weight gain in many, the babies are diagnosed with “reflux”, or allergy to something in the mother’s milk. But these diagnoses can only be made if one does not look at the whole picture and and watching to see if drinking from the breast or not. Watching the baby at the breast will verify that the baby is pulling, crying, popping off and on the breast when the flow of milk slows.

 

I commonly hear from mothers that they were told the baby’s latch was good. When we see the mothers and babies at the clinic, it is clear the baby’s latch could be much better and we show then how to make a shift to the asymmetric latch.

 

With the asymmetric latch, the baby’s chin is in the breast, but the nose is not. The baby covers more of the areola with his lower lip than the upper lip. The photo below shows the opposite of the asymmetric latch. And why the asymmetric latch rather than the other?

 

In the photo 1, the baby has an asymmetric latch, the chin is in the breast, the nose is not. In photo 2, the baby does the opposite – the nose touches the breast and the chin does not. In both cases, the baby has a deeper latch, or a “partial” deep latch; in photo 1, the baby has more of the breast where his lower jaw and gums, and the tongue are.

 

Latching a baby

Photo 1: This baby has an asymmetric latch – the chin is in the breast but the nose does not touch the breast

 

 

An example of poor latch when nursing.

Photo 2: This baby has a poor latch – the opposite of an asymmetric latch, the nose is in the breast, the chin is not.

 

In photo 2, the baby has more of the breast where his maxilla (upper jaw) is. In photo 1, the baby’s lower jaw and tongue can stimulate the breast to release its milk, to stimulate rapid flow. In photo 2, the upper jaw does not move, so the stimulation of the breast is just not effective since the lower jaw and tongue are very shallowly attached to the breast.

 

If you need help with breastfeeding, make an appointment at our clinic.

 

Copyright: Jack Newman, MD, FRCPC, 2017

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