Jaye

Sounds like you're offering this mom a whole slew of info, and she's 
lucky to have you in her corner.

 From what you describe, the only other suggestion I'd have is to try 
again with techniques to latch direct, without the shield at all. 
Sounds like the short shield is too short, but the combination of a 
longer shield with a baby who is not 'getting it' right now to really 
suck hard may be leaving a space between the nipple and the end of 
the shield so that the nipple isn't drawn into it, and everything 
flops about ....?  I've found that soft squishy breasts (as you 
describe) go really well with a baby who can't seem to latch if you 
can ensure that the nipple gets right to the 'S' spot - the junction 
between the hard and the soft palate, right at the back of the baby's 
mouth.  It's much easier to get this to happen with squishy breasts 
than with firm ones.  The trick is a tea-cup technique with the 
areola.  Do it for the mom first, yourself.  Then teach her how to do 
it.  Imagine you are trying to latch the baby to the left breast.
1.  Baby is lying across mom in the cross-cradle, head at the level 
of the left breast. She supports baby's head behind and below ears 
with her right hand.
2.  Mom supports left breast with her left hand, using little, ring 
and middle fingers to support breast, leaving finger and index thumb free.
3.  With the index and thumb she takes a little pinch of the areola 
BESIDE the nipple at about 3 o'clock as if she's holding the handle 
of a teacup (in line with the baby's smile, ie the pinch of tissue 
will be parallel with the corner of the baby's mouth)
4.  Tickle baby's lips very gently to stimulate gape.
5.  Once baby opens, mom PUTS the tip of the nipple up IN to the 
baby's mouth, ensuring that the nipple tip is placed high up into the 
palate, as far as possible into the baby's mouth. If a baby cannot 
seem to gape very wide, you can push slightly down on the tongue/jaw 
first, and then up to the palate.
6.  Stimulation of the palate causes the baby to latch down on to the 
nipple/areola mouthful
7.  As soon as mom feels the baby make that strong suck inwards she 
LETS GO of the handle she has on the areola, to allow the rest of the 
breast tissue 'teat' to be drawn in.  This is quite a quick movement, 
timing is everything.
8.  As she let's go of her handle, she MUST continue to support the 
rest of that soft squishy breast very well - as if she is pouring the 
whole breast into the baby's mouth from the back near the ribs (not 
too much from the front near the areola, or this will break the latch).
9.  Voila! - Here's where the mom must just watch and wait and not 
attempt to hurry the baby.  Most moms just hold their breath at this 
stage ...the baby may take an exploratory suck, a pause, another, 
waiting for the let-down to be triggered.  Once he/she obtains a 
little milk, the sucking starts to become deep and even in 
bursts.  Baby must be allowed to proceed at his own pace.  Mom can 
use breast compression at the back of the breast to trigger further 
letdowns as necessary, but she must be very careful not to disturb the latch.
10.  Once the baby learns to form his own teat, and learns that he 
has to 'draw' the nipple into the mouth (learned by being helped to 
do this several times) then mom can simply offer the breast in the 
usual way and not need the tea-cup routine to provide the extra help. 
I've found that babies can learn very very quickly - perhaps after 
only a few 'assisted' latches, and occasionally after only one.

I hope this is explained OK.  I find that it's better to teach the 
mom how to do this at first yourself, so she can see that it really 
works, and then get her to do a return demo.  If you, the LC, were 
doing the above for the mom, you would of course be standing/sitting 
to mom's right, you would be supporting the baby facing the mom with 
your right hand, and your tea-cup hold on her areola would have to be 
on its right-hand side, using your left hand, with your thumb 
downwards (mom helps by supporting the breast well back from the 
areola, so she can just continue supporting her breast once you've 
got the baby latched.

Seeing this brave woman has twins, probably each with their own level 
of competence, I hope she isn't trying to do simultaenous nursing 
just yet.  They each need to become very competent at the breast on 
their own, before this will work.  But reassure the mom that very 
soft breast tissue is the very easiest to work with.  Sounds to me 
like these are just normal babies who haven't yet become very 
competent - probably a little nipple confused.

Please let us have feedback of what you find eventually works.

Pamela Morrison IBCLC
Rustington, England

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