You Gotta Get the Latch

You’ve heard the horror stories. The pain of breastfeeding. SORE NIPPLES. Cracked nipples. Milk blisters. Giving up because it was just too hard. Not making enough milk. Baby was starving. Engorgement. Mastitis.

Before I was a mom, mostly when I was pregnant, I heard one horror story after another after another after another about how impossible breastfeeding is. Several people told me that they didn’t make milk or didn’t make enough milk. Several others told me of the horrible pain breastfeeding caused. So many wonderful, bright women, reduced to one sometimes tearful, sometimes defensive or indignant, sometimes angry statement: “I just couldn’t breastfeed.”

It kind of makes you wonder how our species made it.

The first thing I want to say before discussing this is DON’T PANIC. Learning about latching before your baby is born, or learning about latching if you are struggling, can make an intimidating situation much easier to handle. Don’t be discouraged by the information in this post; take it as a reminder of the importance of a good latch, and commit to making sure you work for a good one. A good, deep latch can be achieved by almost all babies!

I don’t want to discredit in any way the struggle some women have experienced. I don’t want to say that none of them truly had low milk production, and I am certain that the pain they experienced was 100% real. What they experienced was real, but the fact of the matter is this – our bodies were designed to breastfeed our young. This is true of humans and ALL mammals. In a society where breastfeeding isn’t the norm, and women aren’t always around other breastfeeding women, or may never have even seen a woman breastfeeding before doing it themselves, of course there are difficulties. When our mothers and grandmothers and sisters and friends aren’t breastfeeding around us, it seems strange to breastfeed. There’s no one to ask if this or that breastfeeding behavior is normal. There’s no one to look over while we’re nursing and say, “huh, my kids didn’t do it like that, does that hurt?” Women take their breastfeeding challenges extremely personally, and why shouldn’t they? They feel like those of us who advocate breastfeeding as normal and natural are telling them that they have failed.

I want to correct that RIGHT NOW. If you tried to breastfeed before and you didn’t produce enough milk, or you had extreme pain, or your baby just didn’t want to breastfeed, YOU DID NOT FAIL. Frankly, it is more likely that either society, your support system, or both, failed you. But the past is the past. You can’t go back and change it. Forgive yourself, forgive society, and if you want to try again, don’t let your difficult first experience keep you from trying. If you seek the help you need, the second time may be completely different.

If you were not able to breastfeed before and want to try with your next child, or you are trying for the first time, I want to tell you a few key things that I hope will inspire confidence in you.

Almost all women can produce enough milk to nourish their babies.

Breastfeeding shouldn’t be painful.

Your baby is hard-wired to breastfeed and your body is hard-wired to provide milk for your baby.

 * * Almost all common breastfeeding concerns can be traced back to one source: THE LATCH. * *

 * * * Master the latch, and you can overcome most common breastfeeding concerns. * * *

Let’s take a look at latch. What exactly does that mean? The term “good latch” is thrown around a lot, and a lot of moms don’t really even know what it means. Lots of moms think that latching just means that the baby is suckling at the breast and transferring milk, but it’s so much more than that. A truly effective latch means that the baby has a substantial amount of breast tissue in his mouth during a feeding, and is stimulating the breast to let milk down and produce more milk.

Poor latch is associated with several breastfeeding challenges. Often nipple pain, cracked nipples, nipple blisters, poor production, engorgement, plugged ducts, mastitis, and baby refusing to breastfeed can be traced back to not establishing an effective latch.

It’s more than the nipple.

An effective latch is established by ensuring that the baby takes much more than the nipple into her mouth at a feeding.

Here’s some ways to work on the latch. First, as hard as it sounds, RELAX. If you are stressed out, your baby will sense it and it will stress her out, too. Second, every time you latch, keep in mind that it is ALWAYS ok to de-latch and start over if it doesn’t feel right. And if it doesn’t feel right, there is probably a problem.

When you go to latch your baby on, you don’t want to center your nipple in his mouth. Doing that will result in not enough breast tissue making it into his mouth and making him have a shallow latch. Think about lining up your nipple with his nose. Tickle his cheek until his mouth opens wide, like he is trying to take a big bite of an apple, then bring him to your breast chin first and quickly roll his mouth over your nipple. Bring him to you, not you to him. The ideal positioning is for your nipple to be going toward the roof of his mouth, not the middle of his tongue. Ideally, the lower lip will first contact the outer part of your areola and the last part of his mouth to make contact will be his top lip.

Here’s some drawings of what it should look like: http://www.breastfeedinginc.ca/content.php?pagename=doc-WL

It shouldn’t hurt to latch. A tiny bit of pain in the first few SECONDS is ok. And yes, most women go through an adjustment period where there is some discomfort as they adjust to the feelings associated with breastfeeding, but it shouldn’t last more than a week or two. Pain after the first few seconds during nursing or pain after nursing is never a good thing. “Toe curling” pain at any time is NOT OKAY. If you are experiencing severe or ongoing pain, something seriously needs to be addressed, and it can be corrected. Once you get that “good” deep latch after having had a poor latch for a period of time, you will probably immediately get a feeling like, “Oh, I get what this is supposed to feel like.

Why don’t all babies latch correctly?

Some babies, if placed on their mom’s belly just after birth, will actually scoot themselves up their mothers’ bodies and latch themselves on with just a hand supporting the baby’s back to keep her from falling. It’s a pretty amazing instinct, actually. Skeptical? Check it out. But we don’t live in a world conducive to letting this happen. We’re in hospitals when we give birth for the most part. A third or so of us have c-sections. We’re impatient. We’re skeptical. We’re clinical. We’re results oriented.

So, our baby’s first latch is most often after baby’s first bath, heel stick, eye ointment, etc. The necessity of the separation there (or lack thereof) is for another post on another day – let’s just accept for now that this is what most often happens.

Bottle (or Pacifier) Use. After birth comes the numbers. The weight. The bilirubin level. The blood sugar level. If any of those weights concern our medical professionals, they may tell us that our milk is not enough. Again – another post for another day, but it happens. Some women, whose babies don’t have the “right numbers,” are told to supplement, and we undermine the baby’s latch by giving him a bottle. When the baby learns early to latch on to the bottle, he will then try to latch on to mom the same way. This is called “nipple confusion.” A bottle has a more narrow nipple and requires different muscle movements for sucking. Milk flows freely from it, so little initial stimulation must take place to drink from a bottle, whereas the baby must latch to stimulate the letdown when breastfeeding. It is highly recommended by most professionals that bottles and pacifiers be avoided in the early weeks to make sure that babies develop the important deep latch. If supplementation of expressed breast milk or artificial baby milk must take place, alternative methods of delivery such as syringe, tube, spoon, or cup feeding can be considered. 

Pacifiers can be latch-threatening as well. While I could create an entire post on pacifier use in breastfed babies (and probably will at some point), on the subject of latch, I will say that pacifier use can undermine breastfeeding in two ways. First, the latch on a pacifier is more like that on a bottle, and babies who use pacifiers are more likely to have nipple confusion. Second, giving a pacifier to a baby who wants to meet his sucking needs gives mom less opportunities to latch him on at the breast, further undermining her efforts.

Lack of familiarity/education. Some moms are told their numbers are fine, but have never seen what breastfeeding looks like. If you had only ever seen a baby drink from a bottle, it might make sense to think that this is what all babies look like when they eat. So, in some cases, simple lack of knowledge about the need for a deep latch can cause a shallow latch. If you don’t know where the mouth is supposed to go, that the lips should flay, that the nipple shouldn’t be in the center, then it makes perfect sense that your latch looks like what you have seen in bottle feeding babes.

Physiological problems. Most of these are minor, common, and easily overcome. Babies have small mouths. When moms attempt to breastfeed with their round, full sometimes even engorged post-birth breasts, sometimes babies’ mouths have a hard time getting all the necessary tissue. This usually happens after the milk “comes in” a couple to a few days after birth. Mom can often easily correct this issue by hand-expressing or pumping a small amount of milk before the feeding to soften the nipple area and breast tissue just behind it to make it easier for baby to latch on. Occasionally, a baby will have a physiological problem in her mouth that causes trouble latching such as a tongue tie, lip tie, cleft palate, or cleft lip. If you suspect this is the case, seek the help of a professional – see a lactation consultant and/or breastfeeding-friendly pediatrician for help resolving or coping with these issues.

So what happens when you have a shallow latch?

The baby’s lips and/or gums will compress your breast/nipple farther forward than they should, and this can cause a number of concerning things to happen.

Pain. The nerve endings in the most forward part of the nipple are not designed to be stimulated in the same way as those further back in the breast tissue are. And when they are, it hurts. Next time you have a moment, take your thumb and forefinger and pinch the end of your nipple… doesn’t feel great, does it? Pinch about a half an inch up from the end. Still not super pleasant, right? Now compress about an inch and a half back from the end of your nipple, somewhere near just behind edges of your areola depending on the size of yours. Much less unpleasant if you are grasping far enough back. You should feel some fatty tissue beneath where the baby’s mouth should be landing. If you are feeling mostly the skin of your nipple if you pinch where his mouth lands, his mouth needs to open up and go back. Repeated latching too far forward can result in trauma to the nipple and surrounding skin, cracking/blistering of the nipples, and chronic pain during and after nursing.

Poor supply. If your baby isn’t latching well, she may not be removing milk effectively from the breast. Milk removal is the key to signaling your body to make more milk, so if a bad latch leads to less milk removed, that means a bad latch keeps the body from being signaled to make more milk. Lots of moms will spend inordinate time and energy pumping, and filling themselves full of herbs and oatmeal and even dark beer, or whatever their friends have told them will help them make more milk, but never address the root cause: the latch. Now, pumping is important when supply is low, as you want to make sure to remove milk from the breast, but it’s not a permanent solution. And, in fact, if you are pumping and then bottle feeding the baby the pumped milk, you can get yourself into a vicious cycle of perpetuating the shallow latch with the bottle. If you find yourself in this situation talk with a lactation consultant or pediatrician about alternative feeding methods.

A lot of women get into an unfortunate trap where they believe that they simply can’t make enough milk. The fact is, while this is a legitimate concern in a very, very small number of women due to certain medical or hormonal conditions, almost all women can make enough milk to feed a baby. In fact, given the appropriate amount of stimulation and milk removal, most women could make enough milk to feed more than one baby! Low milk supply is generally not a characteristic of the mom’s body. It is generally due to ineffective milk removal, which is often the result of a poor latch (or absence of latch in the case of a pumping mom – the pump removes milk much differently than the baby).

Engorgement, Plugged Ducts, and Mastitis.

When the body continues to make milk but the milk is not being removed from the breast, it can result in engorgement. Engorgement can be very painful. The breast becomes fuller and fuller and larger and larger, and the cells inside stretch to accommodate, which can hurt. This can get mom into a vicious cycle where the baby has a hard time latching because mom is engorged and the nipple area isn’t soft enough, but the milk keeps coming and making the breast fuller and firmer. This is a good time to learn hand expression or dig out the breast pump.

As if engorgement didn’t sound frustrating enough, it can often lead to plugged ducts, which is when milk cells collect and form a mass that clogs the milk duct, often leading to painful swelling and redness, nipple pain, and can lead to blood in the milk (which is generally harmless in small amounts). Plugged ducts can lead to mastitis, which is an infection that causes high fevers, chills, pain in the breast, and is just generally something you want to avoid. One of the best ways to avoid mastitis is to ensure that the breasts are emptied regularly.

Take a look at the Mastering the Deep Latch topic on this side for more information on how to achieve a good deep latch.

If you need advice on how to get a better latch, Contact Megan!

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