I need some help in figuring out the logistics of nursing for a new mom I worked with yesterday. This mom is very motivated but is having a difficult time. She weighs almost five hundred pounds, and she had a c/section birth. She is having trouble moving her legs.  Her baby is six pounds, and is sleepy.  Her breasts are very long and large, larger than basketballs, and the areola is underneath the bulk of the breast. Her breasts reach the top of her thighs.It is difficult for her hands to reach her areola and nipples, and her nipples are very flat and thick skinned.  Even with pumping, the nipple does not protrude much and is the diameter of a quarter. It is difficult for her to see her nipples at all. We finally tried a nipple shield last night, but she cannot see to put it on, and it has to be placed by someone else.  The baby will latch with it, but once he gets tucked up close to her, falls immediately to sleep.  We would wake him up, and he would suck a bit and then he would fall asleep.  Mom pumped after and we fed him colostrum with a syringe.

Please suggest some positions that might help this mom and baby. She does not fit into any of our chairs at the hospital, and in the bed we can slide a pillow alongside her and get him into football hold, yet he seems precariously perched there, as she fills most of the hospital bed. If we put him under her breast, he gets so cozy he doesn't suck at all, just sighs and goes to sleep.  Hopefully he will be waking up better today and she will be feeling better as well. If anyone could offer some suggestions for me, I would appreciate them very much.
Ann Calandro, RNC,IBCLC

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