< If a larger pump flange is needed to
effectively and comfortably pump, wouldn't the same apply to a
shield?  Is there something I'm missing here?>

Not necessarily. Maybe it's the breastfeeding supply manufacturers that
have more to invent.
Maybe some of us need to be more vocal (or inventive).

If anyone noticed, even though I emphasized that the baby must be fed, I
didn't suggest or recommend how.

Every situation needs to be assessed individually,
and perhaps cup or teaspoon might be feasible, at least for part of the
time.

But for many, the time factor and potentially equal "feeding confusion"
possibilities, I know many moms might opt for the bottle alternative for
their EBM rather than finger feeding.

I will confess that the following thought is what crossed my mind. If the
baby ends up learning to use a rubber nipple anyway (making sure the flow
is slow!), this might work:

I have seen some of the different old-style shields still on the market
that use a standard rubber nipple over a larger glass flange that could
accommodate a very large nipple and end up with the sinuses compressing
themselves against the firm inner ring.

I know for a fact, from past years of clinical use, that they definitely
WILL accomplish milk transfer, providing the areola is soft and flexible
and the MER has been stimulated. They have the advantage of being small
enough for a small baby's mouth till it grows.

If used, my caution to the mother would be that when the baby is nearly
satiated and feeling mellow, after most feedings, she should spend some
time "playing games" with the baby.

While making pleasant faces and soothing words and modeling a wide-open
mouth, I would suggest to her that she brush her leaking nipple with its
softened areola close to her baby's lips for 5 or so minutes. No attempt
to force a latch. Just stroking and leaking.

In this way, the baby might be conditioned to retain the association of
the flesh of the nipple surface as a "tasty fun place" for pleasant
hanging out, and one day, in his own good time and facial development,
decide to reciprocate in the game, and grow into latching.

No flames please. Just brainstorming a bit. There are many ways to "skin
a cat" as an old saying goes. Perhaps this might be one possible way to
bridge the gap between birth and full breastfeeding in the case of
temporary "oroboobular disproportion".

Jean
**********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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