He asks me what kind of work I do. We meet over a glass of wine at a party. He is in his late sixties, h
as no children and never been involved in any, so my answer ‘lactation consultant’ doesn’t mean anything to him. ‘Whát do you do’?
And when I explain I assist mothers and babies with breastfeedingissues his next question is ‘What do you actually dó then’?
I tell him how mother co
ntact me for example with painfull nipples. And he wants to know more: what do I do then? So I show him on my fingertip what a difference it makes if pressure is applied to the top (uncomfortable and flow is blocked) or beyond (increased flow and comfort). And how a fingertip is actually similar in size, flow and sensitivity. And that increasing flow and comfort can make breastfeeding a more rewarding experience for mother and child.
“I see’, he says, ‘yo
u are some kind of plumber then. Milk needs to flow freely without any leaks’. Well… yeah, in that sense I am some kind of plumber.
But there is more, I explain. It’s not just technical. As a minimum I have 2 clients, mother and child. And if breastfeeding is not working well an important part of my job is to help them find the cooperation to form a team (again). And then there’s the network around mom and baby
: partners, family, healthcare professionals who need to be involved. Moreover there are also issues that deal with the autonomy of the baby more than with technique, such as bottlerefusal. Then it is my job to help the parents work with the baby to find a good solution that suits the whole family-team.
‘I see’, he says. ‘So you are also a mediator. You’re a plumber/mediator’.
He is happy he understands what I do for a living, and we contently enjoy our wine. Shall I put this title on my businesscard?
The Concorde way of latching on in breastfeeding was developed for tonguetied babies and their moms. It appears to be a usefull alternative hold with many other breastfeedingissues. There is a video about it which can be found here.
And these are the most frequently asked questions with an answer:
No. A really short tonguetie does need to be treated. And even a not-so-short but really restrictive tie may need to be released. It does however make breastfeeding easier while the tonguetie is not yet cut. And it teaches baby to use the tongue properly after cutting.
With a liptie there are doubts about the need to treat; this way of feeding does appear to give a better seal around the mouth and stretches the lip up and out.
When there is doubt about the need for treatment of tongu- or liptie, for example because the tie is not very pronounced or the baby is very tense so the restriction might not be in the tie itself.
If the tonguetie is caused by general tension you often see baby relax within a few days of feeding this way. And quite often after those first day baby will start to extend the tongue more freely. If this does not happen then that is an indication that treatment may be needed.
The hold also seems to work well when every millimetre counts: when baby has a small mouth and/or mom has a large nipple. The open bodyposition allows optimal reach by the baby.
With reflux, because baby is fed in an extended, well supported upright position.
When baby has had a trauma during birth (vacuum birth for example) or has been pushed to the breast too much. In this hold there is no stress around head and neck and baby can hold the head at an angle if preferred.
With older babies who need to re-learn how to drink at breast because there was an oversupply the first weeks of life. These babies often have not needed to latch properly and run into trouble around 5 kg or 3 months of life (whichever milestone is reached earliest).
It often helps babies who drink passively (See ‘why do you think baby learns to drink well this way?’).
And small or vulnerable babies can often drink more effectively this way. This is likely because they do not have to carry the weight of the breast themselves while drinking. And the open bodyposition facilitates breathing.
Yes that is correct. Especially so if baby has a tonguetie, both before or shortly after treatment. By holding the breast so close to the mouth the tongue and lower jaw will inevitably slide under the areola. This leads to an improved milkflow, and gives the baby the experience of more milk with less effort.
As soon as baby gets the idea the support is only needed at first latch.
If this hold is used for reflux such close support of the breast is usually not needed. The support of the body with extended midriff needs more attention in that case.
Actually most often the support is needed only temporarily so the risk is not as high as it might seem. And usually due to better latching the milkflow is improved to such an extend that the breast is drained well.
If support is needed during the whole feed for longer that a few days it is needed to prevent blocked ducts in the lower area of the breast:
As soon as baby is drinking well support breast with a flat hand rather than fingertips.
Express after feeding 1 or 2 times per 24 hrs and use a warm compress and/ors soft! massage around the lower area of the breast.
Allow the breast to move without a bra as often as needed: lean forward and shake shoulders and breasts, do soft yoga like cat/cow and gentle twists.
If after a week precise and extreme support of the breast is needed during the whole feed to allow for painless and effective feeding, then that is an indication this hold is not the (full) solution for the issue at hand. Another way to latch or suppelementary treatment are then indicated.
In order to drink effectively at breast a baby needs to use the lower jaw and tongue. Without adequate grip on the areola an range of motion a baby drinks on mom’s letdown. As soon as the milkflow lessens baby can’t drink well anymore and has 2 options: let go and latch again, or wait until milk flows again. A baby in this position is often a ‘lazy drinker’. In my opinion baby is clever: with insufficient breasttissue in the mouth and no range of motion waiting is the best way to get milk: passive drinking is rewarded.
With a better latch baby will notice that with each jawmovement and suck milk is flowing. So active drinking is rewarded.
Compare this to pressure on a fingertip: place stress on the tip and flow is inhibited unless you ease the pressure. Place fingers beyond the actual tip and flow is increased with action.
That depends on the issue. With a severe tonguetie continuous support may be needed, both before and the first days or weeks after treatment. And with vulnerable babies who lack power to keep hold of the breast. Usually support is only needed for a few feeds or only during the first moments:
Mostly the support is no longer needed once baby gets it and is stronger.
Often the real support is needed at first latch and towards the end of the feed. In between mom can take her hand away for more ease and to facilitate milkflow in the lower area of the breast.
Most mothers release the support automatically because they want to use their hand to drink some water or scratch their nose. If baby then does not let go or slips off all is fine.
Quite often you can indeed correct latch during feeding. Exception is when the first moment is really painfull: take baby off and try again. But if latch is acceptable but could be better, or if baby slipped off a bit then you can indeed correct him or her while drinking. The reason seems to be that baby drinks with lots of space for the mouth, and a relaxed head and neck.
Correction during feeding only works if and when done very gently and discreetly. At any sudden movement the baby will tense and increase pressure on the breast.
If the baby rests in the soft part of the elbow with the head tilted mildy back there is ample room for a wide mouth and a relaxed hold on the breast. You can then gently ‘lift’ the breast back into the mouth if needed, and encourage baby to come closer by nudging the back towards you.
‘Does it make any sense to continue giving the breast now that I have used a breastpump?’
It was obvious my client had read an article in the NRC newspaper on research outcomes on microbiome and breastfeeding. She had not digested all the details but the gist was clear: after expressing with a pump once the microbiome of breastmilk supposedly changed for the worse. There would be more dangerous-sounding bacteria in her milk, and less biodiversity, and the effect would be lasting. This gave her the impression that breastfeeding after expressing as she had done was useless. Lees verder
[English translation pending] ‘Dat heb ik echt niet gezegd!’ denk ik verontwaardigd. Bij toeval kom ik online een oud cliënte tegen die me een op zich leuk berichtje stuurt. Ze schrijft dat ze uiteindelijk ruim 7 maanden met plezier gevoed heeft. En dat ze zo blij is geweest met mijn opmerking die ze aan veel vriendinnen heeft doorgegeven. “Ongeveer een week door de pijn heen bijten en dan gaat het over’.
Mijn eerste reactie is haar laten weten dat ik dat nooit maar dan ook nooit gezegd zou hebben. Maar vlak voor ik het bericht wil verzenden stop ik. Want ik vraag me af wat ik dan wel gezegd kan hebben. Kennelijk heeft zij dit gehoord. Het houdt me bezig want het is echt niet de bedoeling dat dit soort adviezen de ronde doen.
En dan zit ik weken later bij een andere cliënte met aanlegproblemen en op een tepel venijnige melkblaren/verstopte melkuitgangen. Twee duidelijke witte puntjes op de top van haar tepel. Ze heeft ze op eigen initiatief al 2 x geprobeerd door te prikken maar dat gaf vooral een druppel bloed en nauwelijks verlichting. Met beter aanleggen is de pijn tijdens voeden aan beide borsten meteen minder, maar in de borst met de plekjes steekt het en dat is na de voeding nog lang voelbaar. En dan hoor ik het mezelf ineens zeggen: ‘Deze pijn is niet meteen over, het kan nog een of zelfs 2 weken duren voor het echt weg is dus dat is helaas een kwestie van nog even volhouden’.
Ah. Daar is ‘ie.
We spreken het beleid door:
Eerst aandacht voor (veel) beter aanleggen. Daarmee wordt de tepel niet meer afgeklemd en kunnen de blaren/verstoppingen hopelijk vanzelf genezen en doorstromen.
Als aanleggen zo goed gaat dat haar tepels niet wit maar rond en roze zijn na voeden dan kan ze proberen voor voeden de huid warm en vochtig te maken zodat haar dochter de blaartjes/verstopping makkelijker weg kan drinken.
Aanprikken kan ze nog eens proberen als ondanks dat na 2-4 dagen de pijn bij aanleggen duidelijk veel minder is maar de plekjes er nog zitten.
Verder lecithine nemen en als de pijn tussen voedingen in de komende dagen nog te aanwezig is paracetamol of ibuprofen gebruiken.
Zij is opgelucht en blij met een plan, haar partner heeft meegekeken en kan haar helpen, ik schrijf de samenvatting en mail die, en we nemen afscheid.
Met de deurknop al in mijn hand besluit ik toch nog even terug te lopen. “Dat wat ik net zei he, over dat die pijn nog wel even kan blijven, dat is alleen bij dit specifieke probleem. Omdat die verstopping meestal niet in 1 x weggaat. Dus echt niet tegen je vriendinnen zeggen dat ze bij pijn gewoon even een weekje moeten doorbijten he’.
Ze schiet in de lach en belooft het.
Drie dagen later krijg ik een berichtje: blaartjes weg en ze voedt vrijwel pijnvrij. Zij blij ik blij.
How did mothers ever do it? A grandmother I met recently said ‘I wish I’d had support from someone like you when I had her’ while pointing at her daughter holding her grandchild. And from the bottom of my heart I said ‘I wish I’d had support from someone like me when I had my first child’.
How did they manage it, those mothers who came before us? Did they learn breastfeeding instinctively? By seeing nothing but breastfed babies? That is probably part of the explanation. But only a part.
Because almost every culture on this planet allows women a period of confinement after birth. A period where she can rest, take care of her baby and, very importantly, has the help of other women. To teach, show and support her in breastfeeding and taking care of the lovely demanding new baby.
Not only do we as Westerners have cut down on that confinement period, we’ve also over the last decades lost a lot of knowledge about breastfeeding. So we need external help. And time, and patience. Here is a lovely article to support that view: Secrets of breastfeeding from global moms
At last: a manual for the Concorde-way of latching on. Made by a friend who designs lovely things with her colleague: www.watiets.nl
The concorde method is a way to help mothers and babies breastfeed comfortably with a tonguetie, before and/or after treatment. And it is a way to help those babies practice their tongues at breast in order to make breastfeeding enjoyable for both.
It is also a way to breastfeed that many more mothers and colleagues adopt since it is comfortable to use.
This manual has been tested in daily practice. Feel free to download it, to print it if you wish, and to share it. If you have any questions or want to share experiences with the method please do contact me. It is still a work in progress.
A way to breastfeed I’ve called ‘Concorde’ offers a baby the chance to experience and explore why and how drinking at breast is more effective when the lower jaw is well placed under the areola. And the mother can assist her baby in this exploration while she is usually breastfeeding in more comfort. This is especially the case when a tonguetie and or receding chin and similar issues make breastfeeding difficult for both mother and child.
A manual is just an abstract. It is difficult to catch in words what is in reality a way in which mother and child work together in order to achieve comfortable and effective breastfeeding.
This is not a new way to breastfeed. And ‘concorde’ is an odd name for what is effectively a medieval way to breastfeed.
This is what we now call ‘madonna’hold: a baby that is almost horizontal in mothers arms, with no support to the breast at all.
That is quite different from the way the medieval madonna lactans were depicted: their babies are sitting almost upright on their mothers lap, and mom supports the breast actively. She does this in a way we were taught not to do: almost as if she is holding a sigaret. The emphasis of the support however is at the lower jaw of the baby. And the emphasis on the support for the baby appears to be in the lower back, not behind the head.
This is what is offered in the concorde way of breastfeeding. In another post a more elaborate manual will be shared.
Give me a moment on my soapbox?
Recently I’ve heard several times that finding good info on formula is so hard to get. And that that is caused by the breastfeeding’people’ because they prevent parents being educated on formula. And prevent healthcare professionals to be educated on the subject. Recently I saw an article claiming that the higher rate of obesity in formula fed babies is caused by the emphasis on breastfeeding.
Allow me to clarify a few things. Lees verder