I think it is incumbant upon us as practitioners to understand how and why
equipment works -- esp. if we are designing an intervention for a specific
baby.  Otherwise, the equipment may not help or may actually hurt the
intended management scheme.

Haberman feeders do not require suction to be used to drain milk out of the
bottle.  They work entirely on the principle of positive pressure.  They
have a seperate chamber with a flow valve separating the teat cavity from
the bottle proper.  You turn them upside down, squeeze the teat to fill it
full of milk.  This is called priming.  Then the teat is offered to the
baby.  The milk inside the teat can be extracted just using pressure.  In
otherwords, no suction is required to extract it, just the squeeze pressure
exerted by the baby's gums and tongue.  As the milk flows from the teat into
the baby, the valve between the teat and the bottle chamber allows a little
milk to flow into the teat chamber, so after the first priming the milk
keeps re-filling the teat.  The teat has some markings on it which indicate
flow rates.  In one position, due to the way the teat hole is designed, the
baby can not get any milk out.  There is a slow flow and a faster flow
position, both of which are accessed by turning the bottle to line up the
mid-line of the baby's lip with the mark on the teat.

Why are these design issues important?  Some babies, for instance babies
with clefts of the palate, can't create suction (negative pressure).  To see
why this is an issue, poke a hole in a straw and try to suck up some water.
Even a tiny hole breaches the integrity of the vacuum you are trying to
create and vastly increases the work/energy it takes to suck up the fluid.
Babies with clefts get very exhausted trying to nurse and often discontinue
feeds before fully accessing all the available milk.  (This is why post-feed
pumping and supplementation with hind milk is so impt. in managing these
babies.)  The Haberman is a good tool to use to supplement these babies
because they can milk this teat without having to use any suction.  Also the
variable flow rate helps the feeder control and the baby learn to trust the
feeding method  because it doesn't flood them.  Think about how scary it
would be to have a hole in the roof of your mouth that causes fluids to rush
up into your nose everytime you swallow and you'll see why being able to
slow the rate of flow is a good thing.

Babies with swallowing disorders often profit from Habermans.  These babies
quickly develop aversions to feeding because of compromised respiration
associated with being overwhelmed by fluids in situations where swallowing
is dysfunctional.  (This is called drowning). You can offer the Haberman in
the No Flow position to get the baby to accept the teat in their mouth, and
then use the slow flow to help them obtain some milk.

I am unaware of a rationale for the use of a Haberman in the management of
flat or inverting nipples.  If you are planning to transition a baby to
breast, why would you want to teach him or her not to suck?  You want the
baby who is normal who has a mom with difficult nipples to compress AND suck
(use both positive and negative pressure) at breast because that is the
normal way babies nurse.  What isn't normal in THIS situation is the
elasticity of the nipples.  In this case, a pump and nursing thru a nipple
shield will pull out nipples, keep supply stimulated, and keep baby at
breast until nipples evert.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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