history of attachment how has this come full circle? kittie frantz, rn, cpnp-pc clinical instructor...

HISTORY OF ATTACHMENT HOW HAS THIS COME FULL CIRCLE?

Kittie Frantz, RN, CPNP-PCClinical Instructor in PediatricsKeck School of Medicine atUniversity of Southern CaliforniaLos Angeles CA [email protected]

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DISCLOSURE

• I am the owner of Geddes Productions,LLC film maker of breastfeeding educational DVDs & distance learning course called The Baby’s Perspective

• I was breastfed for 9 months

• I breastfed all three of my children

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I have received copyright permission to show these

photos/films/drawings only to the live conference audience.

Handouts, photographing or recording may not duplicate

these images.

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ATTACHMENT from an anatomy

& physiology perspective

©1980,1990 Kittie Frantz

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WHAT DO WE KNOW?

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Best if baby doesn’t take just the nipple

© 1980, 1990 Kittie Frantz

© 1980, 1990 Kittie Frantz6

Gum compression somewhere behind the nipple is best to protect the nipple


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Baby lengthens the nipple into his mouth to form a “teat”

(Ardran & Kemp)


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Posterior tongue moves upward and back to milk the breast


Woolridge, M.W., Ultrasound video analysis for understanding infant breastfeeding. 18th International Conference on Image Processing, Belgium 2011.

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WHAT WE DON’T KNOW

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Hartman group disputes the existence of sinus’ under the areola

© 1980, 1990 Kittie Frantz© Medela Ag

Geddes, D T (2009) Ultrasound Imaging of the lactating breast: Methodology and application, INTL BREASTFEEDING JOURNAL 4;4 11

Breast sinus or bolus?

• Hartman’s ultrasound research shows the lactiferous ducts widening under the areola

• Could this be milk rolling down the duct in a bolus?

© 1980,1990 Kittie Frantz

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Baby’s mouth placement

• Does it matter?

• Makes sense that the tongue moves under the areola to move the milk through the nipple

©1980, 1990 Kittie Frantz

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What does holding the baby have to do with it?


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Old advice was to give no advice to moms while baby was laid on her back

©Ross 15

This position was hard to get baby close & he often took only the nipple

©Quimby

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Moms were told to tickle his cheek so he would turn his head to the breast

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This was hard on baby’s swallowing

©Quimby

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In the 1970’s, Applebaum said to lay the baby on his side at a 45°

angle

© 1969 Richard Applebaum Abreast of the Times: Breastfeeding for the Modern Mother19

We progressed to Tummy to Tummy

© 1990 Spangler AMY SPANGLER’S BREASTFEEDING: A PARENT’S GUIDE. Marietta, GA,20

Legalism began: It became an absolute that ears, shoulders, hips were all lined up

with baby exactly on his side

© 1979 Frantz

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The Royal College of Midwives reviewed Mavis Gunther’s work from the 1940’s and said “slightly rolled back for eye contact while on his side”

© Quimby22

In the 1970’s, Elsa Wood of New Zealand said hold baby’s bottom flush to her body to clear

the airway

©1980, 1990 Kittie Frantz

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Jack Newman talks of holding behind the ears for cross cradle hold

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So what can we conclude?• We thought baby

was comfortable on his side

• But not 100% on his side

• Baby’s pelvis snug against mom clears the airway for opposite hand and side holds

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What can we conclude?

• Baby’s body in a 45° angle is kind to baby due to normal reflux

© 1980 Frantz 26

Then along came the pillows? Make mom comfy?

Raise baby up to the breast?

© 1979 Frantz

© Kay Hoover27

Pillows laid baby flat and interfered with baby’s

45° angle

Four Dee Pillow advertisement28

SOME POPULAR PILLOWSBaby is pictured flat on his side

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What if mom has a short torso?

©1974 Frantz

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If she sits in a chair, elbow support is what she needs

Loving Moms advertisement

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Most women support baby’s weight on their

thigh so baby is in a 45° angle

©Quimby32

Very uncomfortable unless feet are flat on the floor

or supported

© Kay Hoover © Kay Hoover

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Foot rest pitches her back so baby’s weight is off of her arm

© Kay Hoover© Kay Hoover 34

HOLDING THE BREAST

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Old advice was to just nuzzle baby close to

your nipple and not even hold

the breast

© Quimby

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Then we progressed to grasp nipple between thumb and finger and insert

into baby’s mouth

© 1979 Frantz 37

Then the “scissors hold” was changed to supporting the breast in the “C” hold

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Then we began to hear about the wide open mouth so baby can attach to the

areola and not to the nipple

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LET’S STOP FOR A MINUTE…

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How do we get baby’s mouth open?

© 1979 Williams 41

Cadwell says to touch nose to nipple and baby will back off and open

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Newman says to slide nipple back and forth on upper lip

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Renfrew & Fisher say to brush both lips with the nipple

© 1974 Frantz44

Cox says to rub the lower areola on the lower lip

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How can she see her lower areola??

© 1979 Frantz46

BABY FRIENDLY SAYS….

NOSE TO NIPPLE OR

NIPPLE TO LIPS

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Frantz says to touch the nipple to lower lip/chin


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WHAT IS A WOMAN TO DO?

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Infant reflexes say lower lip

© 1985 Frantz

© 1983 K Frantz50

Righard shows baby crawling doing this

© 1992 Righard

© 1992 Righard 51

Smillie says babies plant their chin first on the breast

© 2005 Frantz 52

Colson says babies prone use their reflexes better

© Kay Hoover

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GO PLAY WITH BABIES!

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What starts baby to suckle and draw the nipple in?

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Marmet says suckling starts when the nipple touches the “S” spot on the palate


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That led to instruction for moms to “insert” the nipple pointed

upward to touch the roof of the mouth

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Infant reflexes show that the inner lips touching the breast all at once causes

the tongue to reach forward

© 1980, 1990 Kittie Frantz58

What has happened to the latch over the years?

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READY, SET,

LATCH…

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The “target latch” used to be

centering the baby’s mouth on

the areola

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The “up and over the top of the areola” latch began as women thought they

should “cover the areola”

© 1985 Frantz 62

Newman, Fisher, Frantz, Weissenger, realized that attaching to the lower areola

was best


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It became known as the asymmetrical latch

• Safer for the nipple as tongue and gum are under it


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WHY?

Better swallowsMeans better weight gain

Less nipple trauma

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When we watched babies, we saw them pitch their heads back slightly



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When baby is brought straight in and close, he naturally attached to the lower areola

© 1980 ,1 990 Kittie Frantz67

Babies prone used their head lifting reflex to do this

© 2009 Frantz

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Sounds simple but some new methods try and

force the issue

©UNICEF

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New in concept: The “Hamburger sandwich” deep latch method by

Weissinger, Sullivan, Harvey, Glover

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Glover says catch lower lip to pry mouth open

Glover, JR. “Attachment – The Key to Successful Breastfeeding” teaching aid, 2013. www.rebeccaglover.com.au

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http://www.rebeccaglover.com.au/

Glover…Bring baby up to just cover the nipple

Glover, JR. “Attachment – The Key to Successful Breastfeeding” teaching aid, 2013. www.rebeccaglover.com.au

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http://www.rebeccaglover.com.au/

Weissinger’s drawings of the same swiping down the mouth

Weissinger, D.: A breastfeeding teaching tool using a sandwich analogy for latch-on. JOURNAL OF HUMAN LACTATION, 1998, 14(1): 51-56. www.wiessinger.baka.com

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http://www.wiessinger.baka.com/

Harvey says to swipe from the nose down to upper lip to lower lip to get lower lip out

Sullivan, D.: The Art of Breastfeeding, FIT PREGNANCY, April/May 2001: 104-105.74

I found moms tried hard to bring baby’s mouth up to “cover” the areola with

these methods

© 1980 Frantz

© Bocar

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Fisher, Renfrew say nipple by the upper lip, baby drops the jaw & bring in the shoulders

©1990 Renfrew, M.; Fisher, C.; Arms, S.: BESTFEEDING: GETTING BREASTFEEDING RIGHT FOR YOU. Celestial Arts, Berkeley

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Bringing in the shoulders and not the head is the key

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Having said all of that, what do we see experienced moms doing?

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PUTTING IT ALL TOGETHER

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BABY-LED LATCH

and then Tina Smillie changed it

all !!!

Gift from Patient 89

And then…….

Suzanne Colson looked at what women have been doing since time

began !

Colson, S, et al. (2008) Optimal positions for the release of primitive neonatal reflexes stimulating breastfeedingEARLY HUMAN DEVELOPMENT , 84(7)

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Laid back breastfeedingIs prone better?

BIOLOGICAL NURTURING®: LAID-BACK BREASTFEEDING FOR MOTHERS © 2009 Colson, Makelin, Frantz www.geddesproduction.com

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Prone allows baby to anchor with his hands and lift his head

BIOLOGICAL NURTURING®: LAID-BACK BREASTFEEDING FOR MOTHERS © 2009 Colson, Frantz, Makelin

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Which mom looks more comfortable??

BIOLOGICAL NURTURING®: LAID-BACK BREASTFEEDING FOR MOTHERS © 2009 Colson, Frantz, Makelin

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Magic happens because her hands are free

BIOLOGICAL NURTURING®: LAID-BACK BREASTFEEDING FOR MOTHERS © 2009 Colson, Frantz, Makelin www.geddesproduction.com 97

Which is more comfortable when she gets home?

BIOLOGICAL NURTURING®: LAID-BACK BREASTFEEDING FOR MOTHERS © 2009 Colson, Frantz, Makelin www.geddesproduction.com

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So…which method is best?

• What seems easier for your client to visualize?

• Do you know if what you teach really works for the moms?

• What kind of follow-up do you have to know this?

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Watch her technique when you see her

• Analyze what you see

• What is right…..tell her

• What is wrong…ask her if she wants help

• Moms think there is only “one right way”

• They are confused when “right” becomes “wrong”

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Dancing around the changes you want to make

• “I am sorry you are so sore.”

• Ask permission to change her technique: “Would you like to try something different and see how it feels?”

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Old habits are hard to break

• She can’t see from this angle

• She will try to do it as she has it imprinted in her mind

• Try the self latch!• If less pain….now you

have her attention!

© 1985 Frantz

© 1985 Frantz

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Follow-up

• Self attachment is so easy and instills confidence

• Try prone laid-back position for comfort

• This could be a “method-free” experience!

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It is working if…

• It does not hurt

• There is nutritive suckling

• Baby gains weight

• The baby drives the system!

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We have come full circle letting the baby do it himself!

• It works

• Mom suddenly feels confident

• No “method” means she and the baby are dancing together

• Respectful of baby who doesn’t feel forced107

Any questions?

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history of attachment how has this come full circle? kittie frantz, rn, cpnp-pc clinical instructor...

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