Nice case study, Jean.  I think it demonstrates a really common, and fairly
difficult problem.  How do we assist when the breasts have those variations
you discribe which make the baby so frustrated:  retacting nipples which
disappear when baby tries to latch, milk sinuses which are back beyond the
infant's "reach" and breast tissue which is difficult to compress and
manipulate?

I think you also demonstrate how  to correctly use a nipple shield to
temporize until baby gets slightly bigger and stronger, and how pumping over
time brings out the nipples a bit so baby can begin to get a grip.  While
you didn't specifically mention it, this is the kind of case which begs for
test weighing -- or at least close serial weight checks -- until it becomes
clear that baby can manage to get enough.  Sometimes the work of feeding
with nipples like this is so increased that babies can't get to hind milk.
Post-feed pumping continues to protect the milk supply and provide a source
of expressed milk to use as supplement.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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