Alissa,

It sounds like this mother is so devoted to giving her babies human milk,
and that is a wonderful thing.  Be sure in your working with her to remind
her how wonderfully she is doing, how hard she is working, and what a gift
she is giving to her babies.  

In my opinion, this situation is far from hopeless-- the babies latch on
once a day so at least they know and remember how to do that successfully.
I agree, they are nipple confused.  Things that tend to work well for nipple
confused babies are tongue exercises.  I usually first get everyone who is
around the babies to stick their tongues out at them -- babies are fabulous
mimics and will often stick their tongues out on the first try!  Another
technique I've seen work is to offer a clean finger for the babies to suck
on.  When the sucking begins, apply firm (but gentle) downard pressure on
the tongue for a few seconds, then draw the finger out of the mouth while
still pressing downward.  This draws the babies' attention to the direction
of moving the tongue down and forward.  Lastly, and perhaps most
importantly, instruct anyone who is giving those babies their bottles to
make sure babies' tongues are UNDER the bottle nipples, as they would have
to be to take milk from the breast.  Those Gerber fast-flow nipples are
notorious for making babies put their tongues up so that the flow does not
choke them!  A hard, slow-flow nipple will be easier to accomplish the task
of getting the babies back to the breast full-time with.  Again, ensure that
everyone who feeds the babies knows to place the bottle nipple OVER the
tongue.  The tongue should be down and forward for the bottle feed, just as
for a breast-feed.  The first two exercises (sticking out the tongue and
applying pressure on the tongue) will be good reminders before the bottle is
introduced.

I know those with more experience will weigh in on nipple confusion issues,
as well!

--Diana in NY (also a hopeful IBCLC-to-be)

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