Jennifer, I recently was working with a mother with a similar problem.  The
mother I was working with was a primip and a full term baby.  Her nipples were
very large and long, sorry I did not measure them.  The baby's latch looked
correct but could not get deep onto the breast tissue due to the large nipples.
Baby's oral anatomy had no problems and the suck was normal.  When mom was
finished nursing the nipples were becoming abraded on the tips.  Mother
described the pain with latch as an "8" (a scale of 1-10, with 10 the worst) and down
to 6 during the suckling.  She was grimacing in pain with each latch.  We
worked with more asymmetrical latches but with not that much improvement.  I then
introduced a nipple shield and mom described the pain down to a "4" with latch
and very little discomfort with suckling.
I don't know if you thought about the use of a shield but maybe worth a try.
My plan is to wean off the shield when the baby's mouth can accommodate more
of mom's breast without pain or injury.
Ann Perry RN, IBCLC
Boston, MA

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