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Playing Sherlock

Written by Diana Cassar-Uhl

When we begin our encounter with a mother, whether it’s before she’s discharged from the hospital, on a home visit during the first week, or after she’s struggled to find comfort and confidence in breastfeeding, our assessment of her situation starts with her report:

“My nipples are so painful.”

“My baby’s weight gain isn’t good enough and I don’t want to use formula.”

“There are shooting pains running through my breast. Is it serious?”

“Can I text you a picture of my baby’s last poop? I don’t know if it’s normal.”

We get as much of a history as the situation permits, and the diagnostician inside of us gets to work. We assess the foundational things – positioning, latch, breastfeeding management. Are feeds on demand or on a schedule? Is there a pacifier in the picture? Are mother and baby comfortable? Sometimes, these answers are enough to get the dyad on their way to breastfeeding success for the weeks, months, or years they hoped to accomplish.

Benedict Cumberbatch during filming of Sherlock.
Photo by bellaphon via Flickr Creative Commons

Other times, our detective skills are necessary. The preliminary suggestions brought little or no relief, and it’s up to us to help the mother solve the whodunnit mystery that spurred her to seek our help in the first place. Like any good detective, we have our eyes open for clues (if the “Blues Clues” theme music is playing in your head, that’s a good sign you’ve been a mother or a grandmother in the United States sometime in the last 15 years or so). When we assess mother and baby as a dyad, many clues are revealed. Why does this work? There is no breastfeeding without both a baby and a mother. The dyad is interdependent, a single entity. Baby needs mother, but mother also needs baby. It follows, then, that when something is amiss in one part of the system, we’ll get to the bottom of the problem faster if we look at the whole mother-baby system. Baby’s tongue is firmly attached to the bottom of their mouth? Aha! No wonder this mother’s nipples are destroyed! Breasts are spraying like Old Faithful at every feeding? Gotcha! The cause of those green, mucousy bowel movements!

Often, after I’ve taken out my magnifying glass and started dusting for fingerprints, I realize my culprit was sitting at the dining room table, holding the candlesticks, all along … baby with sluggish weight gain AND mother with repeated plugged milk ducts? Why didn’t I ask first about breastfeeding management before I started wondering about whether the baby had problems absorbing nutrients? Why was I so quick to send the mother researching about lecithin instead of looking at the more obvious causes of her plugs?

Assessing both the mother and the baby will help us get to the root causes of breastfeeding problems much more quickly, and often more completely, than evaluating each separately might permit. When we keep in mind that we are facilitating the establishment, maintenance, and growth of a holistic, two-part system, solving the breastfeeding whodunnits becomes … elementary, my dear.

Diana Cassar-Uhl, IBCLC and La Leche League Leader, enjoys writing to share breastfeeding information with mothers and those who support them.  In addition to her frequent contributions to La Leche League International’s publication Breastfeeding Today, Diana blogs about normalizing breastfeeding in American culture at and has been a guest blogger at Best for Babes and The Leaky Boob.  Diana can be found lecturing at breastfeeding education events around the United States.  She is pursuing a Master of Public Health, and upon graduation hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition.  Mother to three breastfed children, Diana recently retired after serving as a clarinetist on active military (Army) duty in the West Point Band since 1995.


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