In reply to Bonnie Jones, who is seeing a mother with raw nipples, at the
tips:
     Bonnie, you mentioned that the latch, when checked at the meeting, was
now good.  The mother has also been using Jack's nipple remedy for 6 weeks.
I think this is where a bit of thinking form left field is needed.  The
usual things aren't working.  So lefts look at some other ones.
    Two (2) ideas come to mind:
1) Does the damage look like an acid burn?  Does the baby have
gastro-oesophageal reflux (GOR), even of the 'silent'  type?  Perhaps
especially the silent type, as acid may come up without visible milk being
spat up.  At a conference workshop some years ago, a speaker described a
case of a baby who was refluxing, and the gastric acid made the *tips* of
the mother's nipples raw.  In a second case described by the same person,
the baby had pyloric stenosis, later surgically corrected.  The cases were
fixed by, in one case, the mother's decision to wean (before diagnosis) and
in the other case, treatment of the condition.
   As you know, the stomach is specially coated to contain the acid, but the
nipples are not!  Postural changes - during the feed and after the feed -
can help.  After the feed this can mean holding the baby on the shoulder or
at a 30-45 degree angle across the motehr's body, for about 20-20 minutes,
before putting the baby down.  This has helped some of my Mums and babies
with mild GOR.  Obviously, babies with suspected GOR who do not respond to
this simple measure, or where the  problem has gone on for some time, need
medical assessment, in case of oesophageal scarring from the acid burns. For
 more information on Gastro-oesophageal reflux and brfeastfeeding, ILCA has
a
 reat Independent Study Module (ISM) on reflux, and so does the Lactation
Resource Centre in Australia, both very up-to-date.
2) My second suggestion is: Does the baby have an unusually high palate?  It
might mean that the tip of the nipple is getting trapped up there, pointing
up at the vault.  Juggling positions so that a lto more of the breast can go
in may help;  this may require some creativity.
   Remember, though, that for some babies with high palates, there is no
problem as the mother's breast goes well into the mouth and the nipple goes
past the palate 'buble'.  (My own youngest is an example - there were no
nipple problems and I didn't notice till she started solids and could
'pocket' 5 teaspoons of solids in her palate, without swallowing!)
     A final thought.  The idea of cup-feeding is a good one.  I'm not
familiar with the Medela teat and its length, other than in the cdatalogue.
I *have*, however, seen babies whose Mums have large, soft breasts with
small nipples, and who have real difficulty learning to draw out the breast
into their mounth, after experiencing a long straight artificial nipple.
The long artificial nipple is already 'formed' and so the baby doesn't have
to make the mouth movements necessary to draw in a wider area of flesh and
'form' it.  It is a distinctly different experience, and some babies just
don't seem able to unlearn/relearn after the hyperstimulation of a long
teat.
   I hope these suggestions are of use to Bonnie, or as future reference for
someone else.
      Cheers,
           Virginia
            in sunny Brisbnae
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