Susan,
those are great questions.  I had come into the picture after she had gotten
started with another RN.  I noticed that the shield was the 16mm and I think
the other RN was going more on nipple size than anything.  I have learned
alot from shield just in the last couple of days.  I had been told by a LC
that she nearly  always uses an xsmall to get a good seal etc.  I had not
thought of going bigger to get more areola in there and not just the
nipple.  We were exstatic when we got the baby to latch with out the
shield.

As for the SNS I tried both under (as she was shown before I got there)  the
shield and over, but in the corner.  I like the idea of placing it under the
tongue.

Wow what a wealth of knowledge! Thanks
Kristi
(in rural Co with very little backup)

On 7/1/07, Susan Burger <[log in to unmask]> wrote:
>
> Dear Kristi:
>
> A few others are missing something important in this picture that she
> should not only
> have her metformin levels well regulated, but because insulin resistance
> can sometimes
> coincide with hypothyroidism, she should also have her thyroid levels
> closely moniitored.
> With this sort of profile, I would not extrapolate to studies in
> breastfeeding friendly
> cultures of moms who may have either already had children already or not
> have had
> endocrinological problems.  On the other hand I would not discourage her
> in the least
> because it sounds like her main goal is bonding so she is an excellent
> candidate for that
> relaxed style of wanting bonding that is so often key to success with
> induced lactation.  If
> she lived in Manhattan, I would send her to our breastfeeding medicine
> specialist to
> thoroughly explore all issues that could impede her creating a
> supply!!  In lieu of that,
> maybe a good breastfeeding friendly endocrinologist could help her to
> create optimal
> conditions for building a supply.
>
> Two things you did not mention are what size nipple shield you are using
> and where you
> are taping the SNS when you try without the shield.  I may be grasping at
> straws here
> because I am envisioning how tough this particular scenario is to work
> with.
>
> I only ask about shield size because many moms come out of the hospitals
> here in
> Manhattan with the 16 mm nipple shield.  I have only seen one baby once
> able to transfer
> milk from a 16 mm nipple shield and he was under 4 pounds at birth.  The
> most dramatic
> difference I found in milk transfer was one baby who took 30 min to
> transfer 1 oz using a
> 16 mm shield and then proceeded to down an additional 3 oz in 5 min using
> a 24 mm
> shield.  I have typically found that you can get more areola tissue into a
> larger shield.
> Even most 4 pounders I have met can take a 24 mm nipple shield.  Smaller
> shields tend
> to put the baby more on the tip of the nipple.
>
> If you are trying without the shield (or even with the shield) with the
> SNS, I find it much
> easier for mom to attach a baby (especially with those elastic areolas
> that need a lot of
> shaping) if the tube is taped to the breast so that it will be directly
> under the tongue.
> Them mom aims the lower lip deep into the areola with the tube
> perpendicular to the
> bottom lip.  It makes for a much nicer target than the tube in the corner
> of the mouth.  I
> have never actually used the tube the way the company recommends.  In this
> manner, it
> is easy to get the tube into the baby's mouth without a big struggle which
> is especially
> important with attachment issues.  It may even work better with the nipple
> shield too.
>
> I had a flash of one technique that I'd like to try, but then I realized
> with the tube, it
> would definitely be a two-person affair --- or you'd need something to
> suspect the SNS
> from.  I've been having good luck with very elastic areolas with latching
> the baby while
> the baby is draped prone over mom, legs dangling off one side, baby
> diagonally coming
> across mom to latch to the other breast.  The chin seems to sink deeper
> into the areola
> --- and I've even had it work nicely with a shield to get that lower jaw
> in deep.  But
> pragmatically, I'm think this would not work well with tube.
>
> Finally, I think one reason you are not showing milk transfer YET is that
> this mom may
> need time to build the supply.  You might start tracking milk transfer as
> she starts
> responding.
>
> Good luck with this one.  It sounds interesting and challenging.
>
> Best, Susan
>
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