PA-MILC
Newsletter of the Pennsylvania Midstate Lactation Coalition
An ILCA affiliate
October, 2003

Assessing Latch from the Outside, and What’s Happening on the Inside
By Wanda Mertick, RN, MN, IBCLC

The following is part of a “Latch and Positioning” inservice that was developed for St. Marys Hospital Medical Center in Madison, Wisconsin in 2001. The “assessing latch from the outside” is in regular typeface, and “what’s happening on the inside” is in italics. Enjoy!

A. Baby has a wide angle to the mouth (>120 degrees), similar to a yawn at the breast. The nipple along with the surrounding tissue is drawn out and into a teat. The teat is about 2-3 times as long as the nipple at rest, allowing it to extend back into the mouth by the junction of hard and soft palates. The sucking reflex is elicited by stimulation of the palate by the nipple.

B. The chin is planted close into the breast tissue and the nose is clear of the breast. This allows the baby’s head to tip back and clear a nice open, long throat. This also allows for eye contact with mother’s face.

C. The baby is off-center on the areola and more of the areola is exposed above the upper lip than the lower. This allows the mandible to be planted well back on the areola and the maxilla to rest just beyond the base of the nipple. The up and down piston-like movement of the mandible and tongue helps to create a vacuum phenomenon caused by the rapid enlargement of the oral cavity, which is thought to be a contributing stimuli to assist in milk release.

D. Both cheeks are equally touching the breast. This ensures that the nipple/teat is not being pulled in one direction only, which can cause the loss of important tissue contact.

E. Baby’s lips are flanged out and the tongue extends over the lower jaw and cups the teat. The tongue covers the lower gum and the lateral margins of the tongue cup around the teat, forming a central trough in which the nipple lies. Milk is propelled towards the back of the mouth by a posteriorly-directed, roller-like peristaltic wave along the surface of the tongue.

F. The nipple comes out of the mouth elongated but undistorted (not flattened, creased, or pinched-looking). The target for nipple contact is the palate. An inadequate mouthful of breast tissue may lead to inadequate milk stripping. The nipple is likely to be subjected to unrelieved negative pressure because of inadequate milk flow and improper positioning within the baby’s mouth.

To Join PA-MILC, bring your $15 dues to our meeting or send to P.O. Box 821, State College, PA 16804.

If you want to contribute a news item or article to the newsletter, please let me know. I’d also appreciate any feedback you’d like to share. Contact me at wmertick@hotmail.com.