The Missing Link: Breastfeeding support should be our first stop, not our last resort.

When I look back on my early days with baby, I remember it as though I am looking through a foggy lens of exhaustion, uncertainty and overwhelm. A magical time in my life that I was blessed with three times and I will never forget, though I can barely remember. I see that version of myself in the wide eyes of so many new moms. Ecstatic to be holding the bundle of joy they held in their minds and wombs for 9 months yet lost and confused about how to best meet the needs of this new tiny person. It doesn’t matter if it is excessive crying, poor sleeping or the perception of a baby that is not comfortable, new parents will turn themselves inside out to bring the magic back to this new and uncomfortable territory. At The WOMB, we have made it our mission to nurture and support these new families and guide them to a soft landing. With this mission in mind, we really feel there is one missing link and we wish we could help every new family find it.

Getting the latch right from the very beginning and having that latch assessed as baby develops is the key to a great start and a soft landing. Working with one of our IBCLCs (Internationally Board Certified Lactation Consultants) in the early days with baby even when we feel like we have that piece taken care of can change the trajectory of your early days in ways you cannot even imagine. Even if the latch is 95% perfect you would be surprised at what a small tweak could do. If we get these basics covered right away it can make all the difference for long term feeding success and save a lot of challenges down the road.

I recently sat down with our IBCLC team and co-founder and long time doula Lorri Fleming. Below they answer your questions and give their best advice on this. We hope there is a little nugget in here that might help you or someone you love get the most out of their early baby days.

— Dr. Pam Thornton, ND – The WOMB Woodstock

Dr. Pam: We are seeing that breastfeeding support is often skipped over and clients are heading straight for bodywork when their babies have challenges. They perceive breastfeeding as going well and think they don’t need an IBCLC. What are your thoughts on this?

Sarah Harmer: I see this all the time. Moms come in after trying many different practices to find it was a latching issue all along. I would love to see moms come to an IBCLC first and then follow up with other specialities after the latch is figured out.

Dr. Pam: But if a baby is getting lots of milk the latch must be okay right?

Lorri Fleming: Often when milk comes in there is a fast let down, it’s very common to be dripping milk in the first 6 weeks when hormones are high- even with a less than perfect latch the milk just falls out. Many times, baby is not really effectively removing the milk in order to keep the supply up when hormones petter out at the 6 week mark and that’s when many women run into trouble after they thought everything was going great. I have also seen the fast flow get confused with an oversupply, especially if there is gulping, so mom thinks she needs to do something to supress the milk or the opposite where baby wants to feed every hour and they think they have a supply issue; but it’s really just be a latch issue and baby is simply not effectively removing the milk.

Michelle Buckley: I would agree with this, I also sometimes see clients where everything was going well up until that point when supply regulates, even up to 3 months, then supply dips or weight gain falters because the baby may have been relying on the parent’s fast flow and ample supply regardless of the latch. We may then realize that the baby wasn’t able to effectively remove milk as well as we had thought. It can cause some confusion when everything seemed to be going so well. It could be a need for bodywork or due to oral anatomical issues causing the poor latch and milk removal that would need to be assessed by an IBCLC and referred on.

Dr. Pam: What are the things that most commonly go wrong with the latch?

Sarah: The most common problem with a latch is not getting it deep enough. Baby will struggle getting milk without enough breast tissue in their mouth.

Heidi Reynolds: I would add too that with positioning that is less than ideal- no head extension at breast, poor alignment (ie baby’s hips rolling away from mom), newborn being laid on the nursing pillow to feed with no support, etc… These things are so easily corrected with just the slightest little changes.

Chelsea Wright: Shallow latch is one of the most common latch issues I come across with breastfeeding moms. It is sometimes perceived that pain while breastfeeding is normal and this can still happen if the baby is gaining weight. Sometimes other causes of a shallow latch are undiagnosed muscle tension where the head cannot extend well to have chin lead first and to allow a wide mouth for latching. There are exercises that even LC’s can show mother’s to practice at home to improve muscle tension. Other times there are anatomical issues that can interfere with latching such as tongue ties or recessed jaws that need extra support. Shallow latching can lead to painful sores on nipples, cracks and even mastitis. It can cause weight gain issues, gas and irritability in a baby. I have also seen nipple slippage happen and that is usually with poor positioning. I would always advise to fix positioning first! Then work on latch. If you have an improper line up, you will not effectively have your baby on the breast to remove the milk they need and to keep supply up.

Dr. Pam: How would a mom know if there is a latch issue?

Sarah: It is important to look out for pain while nursing and misshapen nipples when baby pops off the breast.

Heidi: Also watch for damaged nipples and/or a baby who becomes easily fatigued at the breast and/or is not gaining weight sufficiently. There are many other challenges that can be related to a poor latch and difficulty transferring milk, including fussiness, poor sleep, slow gain, gassiness and other digestive problems.

Chelsea: In a proper latch, you want to look for closeness of baby to mom, tummy to tummy without any gaps to allow a good head tilt, chin lead, this helps get that wide mouth for a deep latch. A deep latch is where your baby’s lips are flanged, you have long jaw excursions as baby swallows with each letdown of milk, audible swallows, and no sunken cheeks, clicking, jaw slippage or pain at the breast. If the baby keeps popping on and off this has to be explored further by an LC. And anytime is the best time to see an LC. Not all problems happen in the early stages of breastfeeding, sometimes with regressions of sleep, illnesses, changes in lifestyle, babies can develop struggles with feeding and need extra LC support. I do have to say early prenatal breastfeeding education is very important to help mothers understand the basics before baby is born to set the stage for a successful start and early introduction to her feeding support team- us!! :).

Dr. Pam: If the latch is established in the first few days, it sounds like early is best to perfect the latch.

Sarah: It is always better to fix latching issues earlier than later. Sometimes when it’s left then it is no longer just a latching issue, but now a supply problem too.
It is best to see an LC early on in lactation- around day 3-5 when milk is transitioning.

Heidi: In my dream world I’d see every mother within a few days of birth to work on the basics of position and latch and then as needed from there for ongoing issues. I would also really encourage Tummy Time as it is so key for helping babies to improve feeding. I love it!

Chelsea: There are so many benefits to starting early prenatal breastfeeding education. It can help to clear any misconceptions parents have heard and to find out tips and helpful information they didn’t know they needed to know! It is a great start for an early success to breastfeeding and gives knowledge on how to set up your milk supply. I feel once parents meet LC’s and find out who their support team is, they likely return once trust is established and once they know we support any way they wish to feed their child and will develop a unique feeding plan for them to be successful at home

Dr. Pam: Is it ever too late to have the latch assessed?

Heidi: It is important to start as early as possible to see what we can correct. What cannot be solved with basic position and latch techniques really needsome further investigation!! That can include an oral assessment, body work, etc. As lactation moves from being hormonally driven around the 6 week mark, things can begin to shift again and this is another great time to touch base with an LC. Often around this time baby wants to feed every hour and moms are worried about their supply but it is often a latch issue that was not corrected right at the beginning and baby is not effectively removing the milk. A visit with a lactation consultant in the very early days and then again at around the 8 week mark would be my on wish list for every mom….even when things are seemingly going really well.

Dr. Pam: Do bottle fed babies ever have feeding issues that would benefit from seeing one of our LC’s?

Sarah: Yes absolutely they can!

Chelsea: They certainly can! We usually wait until breastfeeding is well-established before we introduce a bottle. Sometimes this is sooner for babies or longer for some who start off with breastfeeding issues. Bottles with different nipple shapes such as a really wide base and tiny nipple change the tongue movements where the tongue learns to change function so when it goes back to the breast it lacks to cup around the breast tissue to remove milk in the deeper ducts (where the fatty milk is stored). That is why I encourage parents to bring along the bottle they are using to their next appointment so we can work on paced bottle feeding and proper flow size and nipple shape if they wish to partially breastfeeding and partial bottle feed.

Dr. Pam: What services would you suggest to help a new family get this right from the beginning?

Chelsea: One of the ways we aim to help get feeding right from the very beginning is to offer a breastfeeding class for families before baby comes. The benefits of early prenatal breastfeeding education are to clear any misconceptions parents have heard and to find out tips and helpful information they didn’t know they needed to know! It is a great start for an early success to breastfeeding and gives knowledge on how to set up your milk supply. I feel once parents meet LC’s and find out who their support team is, they likely return once trust is established and once they know we support any way they wish to feed their child and will develop a unique feeding plan for them to be successful at home.

Our team is experienced with all methods of feeding babies and though establishing a latch may be more mysterious and complicated, bottle fed babies can have feeding issues too. Lots of babies are fed by some combination of breast and bottle as well and we are expertly trained in helping families get this combination right for their unique baby’s needs. We welcome all babies at The WOMB, no matter how they are fed and are here to help you get this right from the very beginning.

Resources for you:

Infant Feeding Clinic and Information

Prenatal Breastfeeding Classes

Breastfeeding and Infant Feeding Cafe (Monthly Drop-In)

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