This case seems very familiar.  I have had trouble before resolving
inability to latch with breasts that are way low with a flat nipple down
there on the end.  I've tried to picture the baby at newborn crawling up
mother's abdomen and discovering that the longed-for nipple was down mom's
side, on the bed sheet.

This baby (7 days now. I saw her when she was 6 days.) was apparently
latching first day, but after a night in the nursery because mom lost a lot
of blood and "needed" to rest, baby has great difficulty drawing this
rounded breast into her mouth. She opens wide but won't close her mouth.
There were pacifiers in her life before I began working with them.  She has
latched on well a few times.  One of which was the first time I was there.
(That often happens, followed by much frustration at subsequent feedings.
Wonder what that is.)  Once she latches on all is fine, she feeds deeply,
big gulps, good form.

Mom rolls nipple and it stands out as it does when she pumps, but baby comes
and gives one attempt and seems to "rub" the everted nipple away. She has
her mouth open on the nipple area (by this time nothing is sticking out) but
won't close her mouth on it. Then she wails. Her frustration level is very
low. It seems that she is waiting for a firm object to touch her tongue.  We
tried a nipple shield but that wasn't right either.

Some babies fuss a bit and root around and keep trying, finally succeeding
in drawing the breast into her mouth, but this baby and others I have seen
go instantly from a try to a wide-mouthed scream.

Mom tried cup feeding, including the soft cup, and spoon feeding trying to
find a feeding method that didn't involve a firm object in the mouth.  Baby
just went out in orbit, no lapping or sipping. So now mom is finger feeding.
Is that any better for this problem than a bottle?  That finger is still
nothing like this mom's soft, smooth, nipple area.

There is also a supply problem for which she is taking fenugreek and pumping
frequently, but the surface this baby must adjust to is the problem.  How
can this baby be fed that will not take her farther and farther from
acceptance of her mother's breast as the greatest breast in the world,
because it is her?

Do breast shells make a nipple stay firmer or just bring out temporarily?

Patricia Gima, IBCLC
Milwaukee