 Hello everyone, so this is another important Session in which I'm going to take you through How babies latched in a live mode? Okay, so I'm going to show you some video clips So that way you you know, obviously I taught you on breast model and the doll But I also wanted to kind of teach you all exactly how baby latches on And you know on real babies actually so here is the first one Here I want to show you what happens when the baby latches on the nipple versus what happens when the baby latches on the area Okay, really good Video here see here basically the pressure is only on the nipple hardly any milk comes and here the pressure is coming on area So obviously you can see the amount of milk which is passing on is you know much more the milk transfer is much more Okay, this is a very powerful video and What I've experienced in all the areas that I work in that Predominantly mothers are latching on baby are just on nipple so that nipple latch is not doing good to Milk transfer so we have to really kind of work hard on Getting that lower-ear latch because with lower latch that will happen the baby will press on with a lower jaw those ducks which are present beneath the You know and then immediately you will start seeing good weight gain just you know a couple of days, you know once All that milk starts coming coming in you will just start seeing amazing weight gain and here Even in US, you know, I've seen by day three day four children are gaining almost 40 to 50 grams a day You know so and obviously because here in India I work in the community So barricade baby comes home and then we train mothers Of course many mothers are taught during pregnancy club, but when they come back, you know, we start training them again on You know on the live baby So it takes a little little more time and effort But if you have access to pregnant mothers start training them on Deep attachment of a layer of law right from last trimester because that will really help them to you know kind of Do well when the baby is born and you will not see a lot of weight loss even in Low birth babies say up to 2000 gram, you know, they gained really good amount of weight So focus on the lower-ear latch big mouth, you know, at least I would say, you know 120 degree minimum. That's what our experience has been And then you know just have that deep attachment and a very basically make sure that you bring the baby very close to the breast So the lips and the chin chin not visible. Okay, so that's what I recommend now. This is another Video where basically here doctors helping the mother Of course, look at look at Doctors kind of fingers, you know She has put her fingers parallel to baby's lips Okay, of course the you is coming from top because doctors helping, you know So it's much easier for a doctor to kind of press you shape from the top Okay, when the baby was coming on the breast you could see that the there was a good extension of the neck So that neck was extended very well now in this what I would have done And if you look at the nipple nipple is retractile Baby has such beautiful attachment, I would at least check one more time, you know Here's the lower lip and I would have pressed it to make sure that Good amount of light looks definitely it shows that good amount of and you can see that hardly Lips are not visible, you know chin is not visible. So baby's really kind of good has good Attachment is already kind of here again. Look at it, you know So what doctor is doing is creating a bite. Okay, and in that bite over here, you know near thumb Basically, so this particular bite will go in baby's mouth. So there's a good amount of you know lower La going in the mouth. Okay, so I'm going to show you one more time. Look at the nipple is kind of Retractile so you don't need to use nipple shield. You don't need to use anything, you know that Again one more thing See how they're waiting for baby to open the mouth. So once baby opens a big mouth Look at that So please understand that don't use nipple shield. You don't need it Just make a bite make a bite in a way. Make sure your fingers are parallel to baby's lips and they all latch beautifully. Okay, of course, it's a lot of effort. Okay, here doctors helping I would recommend that mother should take this baby in a She should try Make sure that you know you send the mother home only after she understand how to hold the baby how to Press the breast how to latch the baby because unless you do that You know, you cannot send the baby home this baby then, you know, if latching is not good and if mother cannot breastfeed and you do not expect mother to get rid of nipple shield and learn this Okay, you you teach them as lactation consultant as you know Expert you teach mother how to hold the breast Even if there's a retic-tile and flat nipple and you teach mother how to check the latch, you know You do not expect you cannot take a shortcut of putting a nipple shield in the hospital And then expect mother to take out the nipple shield and learn on her own. Okay, that's a shortcut So that's a big no. All right. Okay, so let's see the other one Here I want to show you some pros and cons also of a lot of this Positions and the same so here what is happening the the position of the baby? So when you're observing you want to look at the position of the baby So in this the position of the baby is not good. Okay. Look at the ears The shoulder joint should have been here. Okay in the line with your pinna, you know With your ears, but here the shoulder joint is here in the back. That means the body is twisted So this position is I I this is a wrong position What I would do is to just basically rotate the body so that the shoulder joint will be here or something Okay, the body is completely should be facing The breast or the mother's chest. Okay, so that's important one more time. Look at this the body is twisted Okay, so before I even look at the latch I would look at the position of the baby the position of the baby is not good You know that baby will have difficulty kind of swallowing. Okay, so here what again Helicopter is doing is kind of pressing it on the on the breast to look at the latch Okay, so they are here. This is the examination of the latch that they are looking at. Okay. All right So let's see the other one. This is another very good video So here you can see the lower lies in the mouth. Okay, it's pretty much look at the border The lower lip is at the border up a little less outside, but the problem is you can see still there is a little bit of Dimpling happening. This was because even though lower in a latch was there, you know, baby was too far from the breast Okay, so again, I'm gonna show you Okay, so the good amount of little is there. Okay just because you can see little bit of kind of you know cheeks going inside and That's why you know remember I told you in my Kind of presentation that there are three reasons why shouldn't get a little bit of kind of dimpling or you know cheeks do not kind of Full up is one is nipple latch second is upper in a latch third is your Babies too far from the breast. Okay, so in this immediately the correction was done. Okay See good amount of lower in a latch upper lies outside. Okay. Good size mouth. Okay I would have prefer a little bit bigger, but this is because babies too far So when you bring the baby to close very close, you know Immediately the mouth opens up because then more amount of error is going into the mouth, right? So it opens up. So a lot of time Just remember it's not just a chin which should be embedded into the breast but also the lips lips should not be visible Okay. All right, let's see this one. This is another very good video Okay, now here again, just have a look what I recommend this mother's the way she's holding the u-shape It's not correct because it's too close to baby's chin. Okay, and that will block Baby's jaw movement. So I would put this kind of You know fingers a little bit down. Okay, but you also saw that the body was rotated Okay, so when the body was rotated obviously that the baby's chest was kind of further away from mother's chest So what the healthcare worker did basically pushed the baby rotated the baby more towards the mother Okay, third point which is kind of negative in this is look at baby's neck Baby's neck is kind of bent forward. Okay. This is because what has happened that the baby is brought with direct But the nose kind of higher up Then the nipple then, you know, I'm bringing the nose lower than the nipple or in the line with the nipple So here what is happening because it knows is higher up than the nipple a baby has to kind of bend forward Okay, so here look at this this neck is bent forward So in this case what I would do is to bring this baby pull this baby more towards the other breast So that you know baby has to reach to to the breast, you know So here I were a few things I would do I would Delash the baby. Okay, I would tell mother to hold the breast properly. Look at this here You know, baby's mother's fingers are coming in the way, you know, this is not how it should be You should not have the full finger on the breast. It should be only tip tip of the finger not the whole Not not holding the whole Breast with the of the whole finger, but just a tip. Okay, so that way your fingers don't come in the way Okay, then I would bring the baby so that the nose and the nail of the nose is in the line with the nipple Okay, and then I would basically wait for baby to open the big mouth. Okay I would extend the neck a little bit and then bring rotate this body Completely towards the mother. Okay, so again, I'm I'm gonna show you one more time And See once you did that you saw the lips and the chin it has gone completely embedded But even in this situation, I would examine the latch, you know, and I would look at the latch to see if Good amount of lower. I Has gone in the mouth and the baby's mouth is at least 120 degree. Okay One more thing I would do is the ones baby latches on very well Mother does not have to keep holding the breast mother can immediately remove the hand from the breast and bring that hand around The baby. Okay, so that is important that you know, you don't need to keep holding the breast Yes, if the breast is very heavy if it keeps slipping from the Breast and what you can do as I told you in my previous session to to bring the Hand out and then support that breast with the with the elbow joint. Okay, so you can do that But otherwise, you know, you don't need to keep holding the breast. Make sure that the cross cradle Position that hold should not come off. Okay, so that that hand should not come off the come off the neck Okay, so that's important Okay. Now here's another one This is a cross cradle hole look at the extension of the neck. Okay. Now what we're doing is to examining the Latch so no look at the lower lip. It's at the border of verula upper less completely outside. Okay So this is examination of the latch extremely important Not only you have to examine but you have to teach mother how she should examine herself to look at the latch every time Okay, that she needs just maybe first two three weeks because she has to know how the latch should be right What I'm looking at in the latch the size of the mouth Okay, like the opening of them out so 120 degree minimum Then I'm also looking at the lower lip at the border if the at the area is very small then I recommend to have the lower lip at the breast, okay, and Again, you know looking also looking at if the lower lip is kind of curl outward or not And you know also we don't want to see lips and chin at all So once you finish checking the latch you just tell mother to push the baby more into the breast Okay, so that we don't see for lips and chin at all Okay, this is the sideline hole Okay, so here look at the neck of the baby extended beautifully that means baby is kind of pull a little bit Downward, okay, so baby has to extend the neck to reach the breast, okay, and Now what I would do in this case I would teach the mother I would tell mother to kind of completely You know rotate towards the baby and then with that this hand I would ask mother to hold the baby even closer so that lips and chin are not visible And then she can breastfeed, okay So that to you know, I mean obviously we want to teach mothers and we want to do everything You know, but before she goes home, you want to make sure that mother is doing everything You are just examining and watching and seeing her whether she's doing correctly or not because if we keep doing And we have this habit, you know, once we get into this Tea training mode, you know, we want to keep holding the baby. You want to hold the breast We want to do everything, but you know, of course while you're learning you can do all that stuff, but once you know You want to empower mother, so make sure that everything mother knows what to do so that she can do it after going home Okay, so here's another one Again, this is examination of the latch Okay Looking at look at the extension of the neck beautiful extension of the neck I would still recommend a little bit more extension, you know, if possible But again, you know see because they realize small then both the upper and lower lies in the mouth But I would still prefer to bring this baby down a little bit and have the upper lip just at the upper bottle of nipple You know because here if you look at it, this upper part of area is not moving at all. You see, right? This upper part is not moving at all Basically what baby is doing is he's trying to press the lower law with a lower jaw So the amount of area which is near the lower jaw If we can give access to that to the baby, there'll be a lot of pressure All right, so let's see the other one Positive and some negatives in this video so that you understand where the issues come, right? So here if you look at it, basically if you look at the mouth, it's about 90 degrees Okay, so mouth is not very big it should be a little bit bigger than that But what has happened that look at the So here here is your angle of the jaw angle of the mouth, right? And look at the upper a la going in the mouth huge amount of upper a la going into the mouth Though lower lies like in a way little amount of lower lies gone in the mouth Okay, so what I would do and also the neck is a little bit flexed So if you look at it neck with neck is a little bit kind of bending forward Okay, so in this position what I would do I would bring the baby I would not remove the latch so much and also another thing So in this position what I would do is I would just bring the baby Pull the baby towards other breast or pull it pull the baby down towards other breast Okay, so that baby is kind of angle shift and then then you push the baby more into the breast So automatically more area will go in the mouth and then mouth will open up Okay, so I would not delatch this baby. I would not remove the latch and then relatch again I would just basically kind of adjust the position of the baby So that there is more of extension of the neck and more of the lower a la going in the mouth Okay, so here look at this Look at the, it's basically predominantly baby is just you know Look at the dimple. Do you see this dimple? Right? This dimple is happening again because of the upper a la is more in the mouth Maybe it's too far See, there is no foolishness of Do you see this? This is called dimple If you see dimple in this, definitely issue you need to work on the problem that why baby salmon dimple fix it and you will see the results Okay, all right So here's another one. This is babies coming from the top Look at the mouth, look at the size, look at this beautiful more than 120 degree but still there is a dimple Do you see over here? There is a dimple Okay, why again because more of the upper a la is in the mouth Okay, so what I would do and look at the neck of the baby Neck of the baby is flexed, it's flexed like this Okay, we will not able to swallow for too long Try to flex your neck, try to put your neck forward and drink water You will have one or two shots and you will not get tired, right? So you are also try to make sure that the neck is not flexed So even in a breast crawl, try to keep the head of the baby lower than the breast Okay, so that baby tries to reach and have a little bit of extension Okay, so one more time Look at this And as because baby is too high up, the nose is getting pressed Right, if baby was lower than that, you know, the neck would have been extended and the neck would have been flexed Okay, this is our lovely baby Okay, here's another one So we are basically able to visualize that Okay, only in the neck is slightly bent forward So I would pull the baby a little bit down But here the lips and chin are visible Okay, so in this case, what I would do is to, I would just tell mother To press these babies more inside the breast Take it more, kind of have a deep attachment Take baby closer, okay The mouth should be completely embedded into breast And those baby gain a lot of weight Okay, all right Here also you can see, first thing I see is like, there's a little bit of, you know, kind of dimple You see, there's not only Okay, because in this case also what has happened, baby has more of an upper line in the mouth See, a lot more upper line in the mouth Baby is pushing, you know, putting the pressure But because a lot more upper line in the mouth, you know What's happening, you can also see again here also There's a little bit of dimpling, there's no fullness Because again, you know, more of an upper line in the mouth Okay, I would push a little bit more I would, in fact, pull the baby lower And I would push the baby more into baby's mother's breast Okay, here because I can see lips, I can see chin, I can see everything This baby is too far That's why baby is kind of, see, you can see baby is kind of making that noise Because baby is hungry, but not getting a good amount of milk transfer Okay, so this is what I would do Okay Here, another very nice video So if you'd like to do cross cable It's your hand supporting your breast It's your hand supporting your breast It's your hand supporting your breast It's your hand supporting your breast Remember that other hand of the baby can do just a little less Just a little less Like, the lower part of the breast See how, now what we do is this T comes to meaning the upper lip Okay, okay Okay, now, let's pull the baby off Could have been in, he says also Could have been in, he says also So rubbing up your lower lip would be slower Only thing is, because the breast is not healthy You know, that's why they have me Because if you roll the breast properly With both kind of fingers paddled to the upper lip and the lower lip Then the latch would be really good Here, I would still check the latch So here, once the baby latches on I would still press it over here And look at whether the lower lip is in the mouth Just by looking at it, you will not be able to know Because many times when the baby is very closely attached To the mother, sometimes the mouth is very small And they're still sucking on the nipples But you cannot make out So you have to examine the latch Okay, so this way This way You know, of course, look at the chest It's facing upward So the neck is rotated So I will bring the baby, I will rotate the baby Here, you know, this is a cradle sword Mother is holding another C-shape There's a lot of dumpling over here You can see the dimple of the baby But there's a dimpling over here So that means the latch is not good See the other one These are pretty much the babies, of course Look at the babies This neck is too hyperextended We don't want so much hyperextension in the neck So you can see more of the upper lip Going into the mouth You see, even in the mouth is not that Which is a little bit bigger And you can see the lips and the chin So, you know, we need to kind of relatch this baby Okay, because look at the lower eyes And outside the mouth And full upper eyes in the mouth So this baby will not have a good plans for This baby is only nipple feeding You can see it, it's just Mouth is extremely small, only 45 degree Okay, it's just nipple feeding Here, look at this one Baby's body is twisted So the chest is facing up The chest should be facing the mother Okay, look at this hand over here On the other hand of the baby You know, it's coming in the way So this hand should be underneath the breast Okay, baby should be completely rotated The neck is also flexed The neck is flexed And you see, it's like, you know The lower eye is pretty much outside You can see it, right And, you know I would relatch this baby Right, so the position is wrong Latching is not Necessarily good, you know Mouth is big So once you basically You know, put the baby in a proper position And then make sure that the neck should be extended So don't bring the baby with Nose very high up Okay, this is of course Baby is completely rotated The lower eye is outside The upper eye is in the mouth Okay, obviously The position is not coming Okay, here Again, more of the upper eye is in the mouth Right, look at the neck of the baby Flexed Flex forward Bend forward So here the lower eye is outside And the upper eye is in the mouth Okay, so And also the way baby is brought It's wrong Okay, alright Here, this is the premature baby This is what I see all the time In the female area Mother holds the baby In a pretty small No proper neck support Here See, the nose is much Higher up than the nose Right, over here Mother is holding the breast Incorrectly Right, what she is doing She is holding her fingers Not parallel But now she is trying to put Lots more upper area in the mouth You see how difficult it is for mother To latch the baby Because she cannot control the neck She cannot control the way She is holding the breast She is making the breast When the breast is long like this How will you have the lower area in the mouth It's like holding a burger Like this, we cannot have Anything which you hold You can't eat the food like this You have to have a finger parallel to lips Okay, so here in this position These fingers are not parallel to lips Actually, I would put one finger over here Okay, right at a Another thing is baby is kind of oblique You don't want to keep the baby Diagonal, you know You keep the baby absolutely straight Okay, so that the lips are At 9 o'clock position And lower lip other Okay, here see look at this It's only a dip going into the mouth Okay, so that's it Here is your mother one Again, same thing You can see that the lower lip Is ending over here The whole lower lies outside More of upper lies in the mouth Baby is kind of Position is rotated Maybe needs to be More closer to the mother Where mother is holding the breast She's holding it, she's making this long So when you have this It's so long it's so long Then obviously you will not have You will have only dip going into the mouth I would have put that finger over here But this is again, it's a cradle hold And look at baby's neck, baby's looking like that Okay, so again Like that's why I prefer cross cradled hold Because in cross cradled hold you can control the neck You can have the extension of the neck You can hold the breast correctly There are two lids, you know It's these issues that I've faced And first 5 years no wonder I was not getting results Because I was showing the same way You know, so anyway Here there's one cliP I have for cleft lip You know To be frank I have not seen too many cleft lip Pallet patients So I don't have much experience in it But you know here one of the colleague Had shared this clip This is kind of a saddle of a horse shape Saddle of a horse Saddle of the horse, the baby is sitting on mother's lap, you know how you sit on the horse This is her saddle position. And then what she is doing is basically she is doing perfect. Her fingers are parallel to baby's lips. See there is a beautiful support, next support. And then there is extension of the neck. So what she is doing she is trying to press the breast and the baby has a hole over there. So she is trying to put that breast in that hole so that baby can get a seat. You need to have a seat to create that structure. So when you don't have a seat, you will not be able to create a structure. So here with the help of breast, she is basically closing the gap. And this is a beautiful position of the breast. Saddle of the horse