The Three Sucklings

By Ros Escott, Australia - from Lactnet, Mon, 6 Nov 1995

Hospitals all over the world are now implementing the 10 Steps and there are overwhelming data to support the long term value of these breastfeeding-friendly practices. I recently spent 12 days doing a project for WHO in Thailand, where 70% of hospitals are now Baby-Friendly. It changed my thinking about breastfeeding and made me realise just how many of the problems we LCs face, and people on the Lactnet write about, are iatrogenic. The Thai breastfeeding message is ubiquitous, elegantly simple and the answer to everything.

“The Three Sucklings”

  1. Early suckling (ie on the delivery table),
  2. Frequent suckling (exclusive breastfeeding and NO mother baby separation)
  3. Correct suckling (good attention to position and attachment.)

These are not token messages. No separation means that the mother stays with the baby for everything. Frequent suckling means that the mother lies in bed on her side with her baby at the breast. If you asked a mother how many times per day she feeds, she would look at you strangely. Better to ask whether the baby ever falls into a deep sleep and drops off the breast for a while - they occasionally do.

We saw a lot of abandoned plastic cots. I was told that despite rooming-in there had been a problem with jaundice. They got rid of the cots, put the babies in the beds, and the jaundice stopped. That’s frequent suckling folks, not what we play around with.

When you need beds desperately and mothers can't be discharged until breastfeeding is established and going well (2-3 days), you do everything to make it work. The mothers feed all day and the nurses walk around fine tuning positioning and helping as required. Where was the hypoglycemia, engorgement, sore nipples, babies unable to latch, etc.? Not to be seen. I never heard a baby cry. Yet these are medicated deliveries, 100% episiotomy, up to 16% caesarian.

It seems that if the "Three Sucklings" are really done well, the rest can fall into place. Now if every doctor and every nurse throughout the world knew and practiced these three things.... we could be bored, not burnt out.