In addition to the great suggestions already posted,
the VN's need to find out, either by observing a
feeding, or by asking the mother, *how the nipple is
shaped when the baby detatches*.  Marsha Walker states
that the shape of the nipple after feeds is
"diagnostic"; I have found this to be accurate, and
very useful in my practice.  Even a skilled postpartum
nurse can assess what looks like a good latch *from
the outside*, but if the nipple is flattened, wedged,
or blistered (or worse--OW!) when the baby comes off,
the latch is ineffective/incorrect and further
assessment and intervention by an IBCLC is warranted.

Carole


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