 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 gonna 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 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 aryola 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 aryola 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 these 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 the clover in a latch because with lower latch what will happen the baby will press on with a lower jaw those ducks which are present beneath the aryola and then immediately you will start seeing good weight gain just in a couple of days you know once all that milk starts coming in coming in you will just start seeing amazing weight gain and here even in US you know I've seen by day 3 day 4 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 more time and effort but if you have access to pregnant mothers start training them on deep attachment of aryola 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 2,000 gram you know they gained really good amount of weight so focus on the lower 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 are 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 doctors kind of fingers you know she has put her fingers parallel to baby's lips okay of course the U is coming from top because doctors helping you know so it's much easier for a doctor to kind of press U 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 retracted so that nipple is you know even though nipple is retracted baby has such beautiful attachment I would at least check one more time you know over here I was saying here the lower lip and I would have pressed it to make sure that the good amount of it looks definitely it shows that good amount of and you can see that the hardly lips are not visible you know chin is not visible so baby is really kind of good has good attachment you know baby is already kind of here again look at it you know so what doctors 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 lip going in the mouth okay so I'm going to show you one more time look at the nipple is kind of a retractile so you don't need to use nipple shield you don't need to use anything you know that here 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 beautiful okay 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 doctor is helping I would recommend that mother should take this baby in a healthy way and she should try it from underneath because eventually after going home she is going to do it it's not another doctor or the or whoever you know so 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 retractile 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 lot of the 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 okay so this position is I this is a wrong position what I would do is to just basically rotate the body so that the shoulder joint would be here somewhere 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 healthcare worker 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 okay so here you can see the lower lip is in the mouth okay it's pretty much look at the border the lower lip is at the border upper lip is outside but the problem is you can see still there is 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 going to show you okay so the good amount of lower lip is there okay just because here you can see a 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 lip latch third is your baby is too far from the breast okay so in this immediately the correction was done okay see good amount of lower lip latch upper lip is outside okay good size mouth okay I would have prefer a little bit bigger but this is because baby is too far so when you bring the baby to very close you know immediately the mouth opens up because then more amount of lower 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 waist is 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 moment 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 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 baby is brought with direct with the nose kind of higher up than the nipple then you know bringing the nose lower than the nipple or in the line of the nipple so here what is happening because the nose 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 with 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 the nose 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 going to show you one more time okay 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 good amount of lowerlla has gone in the mouth and the baby's mouth is at least 120 degree okay one more thing I would do is the once 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 and if it keeps slipping from the breast then what you can do as I told you in my previous session to to bring the hand out and then support the 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 look at the lower lip it's at the border of verula upperlla is 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 the mouth so 120 degree minimum then I'm also looking at the lower lip at the border if the 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 perlips 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 pulled 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 is 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 the air is 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 Erilla is not moving at all you see right this upper part is not moving at all basically what baby is doing is baby is trying to press the lower law with the lower jaw so the amount of Erilla which is near the lower jaw if we can give access to that to the baby there'll be a lot of pressure okay all right so let's see the other one so there are a few issues in this okay I want to show you some 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 degree 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 is your angle of the jaw angle of the mouth right and look at the upper Erilla going in the mouth huge amount of upper Erilla going into the mouth though lower Erilla is like in a way little amount of lower Erilla has 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 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 you can see is the lips are visible chin is visible that means baby is too far okay 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 Erilla will go in the mouth and then mouth will open up okay so I would not de-latch this baby I would not remove the latch and then re-latch 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 Erilla 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 do you see this dimple right this dimple is happening again because of the upper Erilla is more in the mouth and baby is too far you see there is no weakness of you see this this is this is this is called dimple if you see dimple then there is 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 baby is coming from the top okay 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 Erilla is in the mouths 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 you 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 steps and you will not get tired right so you're 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 increased okay this is this is our baby okay here another one so here basically I have a lot of lower lids there okay only in the neck is slightly kind of bent forward so I would pull the baby into down but here are 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 you are 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 okay because in this case also what has happened baby has more of a parallel in the mouth see a lot more parallel so it's baby is pushing you know putting the pressure but because a lot a lot more parallelizing about you know are you seeing the dimpling 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 a parallelize in the mouth okay I would push a little bit more I would 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 sit in I can see everything this is 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 video so 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 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 okay so that in this way you know the of course look at the the chest is facing upward so the neck is rotated so I would bring the baby I would rotate the baby here you know this is a cradle mother is kind of pulling another c-shape there's a lot of dimpling over here you can see the dimple of the baby yeah but there's a dimpling over here okay so that means the latch is not okay see the other one these are pretty much your babies of course local babies you know but this neck is too hyper extended we don't want so much hyper extension in the neck okay and so you can see more of opera like going into the mouth okay to see even in the mouth is not that you know which will be a little 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 lies and outside the mouth and full upper lies in the mouth okay so this baby will not have a good transfer this baby is only nipple feeding you can see it it's a 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 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 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 kind of 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 lower lies outside upper lies in the mouth okay here again more of upper lies in the mouth right look at the neck of the baby flexed like this flex forward you know bent forward so here the lower lies outside and upper lies in the mouth okay so and also the way baby is brought it's wrong okay all right here this is the premature baby this is what I see all the time in the mother holds the baby in a pretty mold no proper neck support okay um here see the nose is much higher up than in the first one okay right over here right mother is holding the breast incorrectly right what she's doing she's holding her fingers not parallel but now she's trying to put a lot more upper you see how difficult it is for mother to latch the baby because she cannot control the neck you know she cannot control the way she's holding the breast she's making the breast kind of long okay when the breast is long like this how will you have the lower in the mouth it's like you know holding a burger like this we cannot have have anything which you can't eat the food like this and a big bite 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 uh 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 nine o'clock position and the lower lip at the okay here see look at this it's only uh a nipple going into the mouth okay so that's here is your another one again uh same thing you know you can see that the lower lip is ending over here the whole lower lies outside more of upper lies in the mouth right uh baby's kind of fall position is rotated okay uh baby needs to be more closer to the mother okay and look at 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 that obviously you will not have you will have only nipple going into the mouth I would have put that finger over here but this is again it's a cradle and look at baby's neck baby's looking like that okay so again like that's why I prefer cross-corded hold because in cross-corded hold you can control the neck you can have the extension of the neck you can hold the breast correctly you know with fingers parallel to lips you know because it's just issues that I faced and first five years no wonder I was not getting results because I was I was showing the same way you know so anyway here there's one clip I have for a cleft lip you know uh to to be frank I've not seen too many cleft lip patient so I don't have much experience in it but you know here one of the colleague had shared this clip and it's really nice this is kind of a saddle of the horse shape saddle of the horse baby sitting on mother's lap okay like a you know how you sit on the horse so this is for a saddle position and then what she's doing is basically uh she's doing perfect actually you know her lips her fingers are parallel to baby's lips see if there's a beautiful support okay uh or neck support okay and then there's extension of the neck so what she's doing she's trying to press the breast and baby has a hole over there so she's trying to kind of uh you know put that uh uh breast in that hole so that baby can get a seal you need to have a seal okay uh to create that structure so when you don't have a seal you will not be able to come with a creative suction okay so here with the help of breast she's been deep closing the gap and this is uh beautiful position for the neck and the neck so you can get a