Dr Phil Hammond, broadcaster and GP returner in Bristol

Breast-feeding: more than what comes naturally

As a doctor, people often ask me, 'What can I do about uncomfortable latch?' To which I reply, 'I haven't the faintest idea what you're talking about'. Actually, it has only happened once, with an American woman who was amazed at my ignorance, and horrified as I reached for the speculum. Apparently, uncomfortable latch is a polite Americanism for bitten nipples.

Now, we all know the benefits of breast-feeding. There are more than 4000 species of mammal,1 all making different milk to suit the specific nutritional needs of their offspring. Hence, you don't give cow's milk to a human baby, or vice versa. But no matter how much you repeat the 'breast is best' mantra, just saying it isn't enough.

My American breast-feeder referred me to the US Preventive Services Task Force, which has conducted a systematic review of 35 studies, including 22 randomised controlled trials of breast-feeding counselling.2 It found insufficient evidence that pamphlets and ad hoc advice improve the take up of and persistence with breast-feeding.

What is needed is structured education and counselling programmes. These may involve as many as eight sessions, lasting between 30 and 90 minutes, lead by nurses, midwives, 'lactation specialists', or other experienced breast-feeding mums.

It seems you can't just bung a baby on a breast and expect it to get on with it. Women need both knowledge and practical skills to overcome problems and perhaps even enjoy the experience.

Nearly two-thirds of women start out trying to breast-feed their babies, but the number of those who are still successful at 6 months has reduced by half. Now we may not have an abundance of lactation counsellors in the NHS, but if we believe in breast-feeding, we need to have the skills to deal with problems like uncomfortable latch.

Until I was forced by my ignorance to research into this, I thought that breast-feeding and teeth were mutually exclusive. But my friendly health visitor assures me that if a baby or toddler is breast-feeding correctly, it can have a mouth full of teeth without hurting its mother. The fear of teeth is often worse than the teeth themselves, because a baby being fed properly isn't able to bite. With the nipple right back in the mouth, the closest the teeth can get is to the areola, which is, apparently, much less sensitive than the nipple itself. Conversely, a toothless baby can cause plenty of pain by clamping its gums on an insufficiently protruding nipple.

This all sounds well and good, until you remember some babies love the excitement of nipple trapeze, hanging on literally by the skin of their teeth. The introduction of a cup with a plastic spout can also lead to nipple confusion, with the breasts being treated like some inanimate object. The old fashioned (and I suspect reflex) response to nipple biting is to let out such a loud exclamation that the baby is frightened into never trying it again. Instant behaviour modification works for most of us, although sensitive babies can go on 'breast strike' if you shout at them too much.

Yanking a biting baby off is also a no-no, causing more damage than the bite itself. It is much easier to slip a finger in and break the suction. Blocking baby's nose by a gentle pinch or pulling into the breast until he/she has to let go also works. Changing position, offering a teething ring to persistent biters, and praising baby for latching on properly are worth a try, but persistent biting may just be a sign of full-up boredom. The bottom line? Hungry babies just want to swallow. And if you digest this, you can put a tick in the 'breast-feeding update' box on your appraisal form.

1. www.bbc.co.uk/nature/animals/mammals/explore/record.shtml
2. US Preventive Services Task Force Counseling to Promote Breastfeeding. www.ahrq.gov/clinic/uspstf/uspsbrfd.htm G


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