Hi Jean,
I hadn't really thought about an overactive MER... I couldn't detect any
definite signs of such, no gulping, uneven suck/swallow ratio.  What else
can I look for to determine that?  But it is a good thought and I'm glad you
brought it to my attention. It does explain the bunching of the tongue.

I wonder though, why would the nipple *not* be pinched when she is leaning
over the baby and *that* was when she said she was gulping and sputtering...
I wonder if early on she had a very strong MER and this is something the
baby has learned and still continues to do even though the let-down is not
so strong?  If so, any ideas on how to counter this?  I went over suck
training with her to encourage the baby to bring the tongue down over the
gums and to cup the finger with the tongue.  He never did get a good suck on
my finger, though, although he seemed to have a good seal and sucking
vigorously at the breast.

In any case, I did even lay down on the floor of my office today and
demonstrate anti-gravity positioning with her <grin>.  I will call her
tomorrow and see if she wants to try this for 48h as you suggest.  Thanks
much!

To Kathleen, re the APNO, believe me we did try to get the APNO, but the
same OB who prescribed the Diflucan refused to order the APNO, saying it
wouldn't help.  I faxed her Dr. Newman's info on it and it was still no-go.
According to the mother, the Diflucan was only ordered to "shut her up".
Her pain is not a constant pain or a burning pain.  Her nipples are sore
between feedings and painful during and for a short while after.  She says a
4-5 on the 1-10 scale through-out the feeding.  With the shield, there is
little, if any pain.  With tweaking the latch a little bit more she was able
to get down to 2-3 on the pain scale, but the nipple was still pinched.  The
baby's tongue looks to me to be a little short and flat, but the palate
doesn't appear high or bubble or anything like that.  What else should I
look for in the mouth?  Thanks for the ideas.

Regards,
Cindi

>Is it possible this baby has learned to hump the tongue and thereby pinch
>nipple as a coping mechanism for a slightly stronger MER/more copious
>supply than baby can handle without trying to stem the flow a little?
>What about consistently triggering the MER 3 full minutes before latch is
>attempted, and always using an anti-gravity position such that the milk
>leaves the breast in a trajectory more like a drinking fountain, with the
>baby's oronasal passages always above, rather than being "under Niagra
>Falls" with the oronasal passages in a dependent position to the nipple.
>Or a least, a neutral gravity position, after triggering the initial MER
>a full 3 minutes before latching.

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