Lactnetters,
In the discussion regarding bottle nipples, I like to remember the fact that 
a human breast will spray milk at a very fast rate, and the baby isn't 
"working" during this phase of feeding. This occurs after the baby has signaled to 
the mother(by initial latch) that he is ready for the milk ejection reflex. No 
bottle nipple has this action and reaction as the breastfeeding relationship. A 
bottle this fast would prove a problem to any baby.
When an infant needs a bottle, I try to use the nipple that seems to 
encourage the motions that this infant needs to help transition to the breast, so 
direct observation of the infant is important.
It is frustrating when a bottle that the family is using is not helping this 
baby, but they have been told that it is most like the breast. I think knowing 
a few different types helps lactation consultants.  However, I don't feel the 
need to know every single nipple out there.

By the way, today's San francisco Chronicle has an article about the UCSF 
Intensive Care Nursery, and there is a photo of a mother breastfeeding her baby 
in the article. It is nice that it is included as a normal part of the infant's 
life. while there is a mention of a bottle, there is none pictured, and 
breastfeeding is the norm. Yeah!
here is the link:
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2004/10/07/MNGII94D931.DTL&
type=news

Fritzi Drosten, RN, IBCLC
Lactation Consultant
Intensive Care Nursery
Children's Hospital at
University of California San Francisco
San Francisco, California

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