Are you doing side-lying positioning with the Haberman?  Able to switch to the Haberman with smallest slit to the nose, switch to longer nipple? Can baby suck a soothie pacifier?  In my experience, it takes longer than 2 weeks for some posterior ties to learn to suck. Also, try a 20 mm shield with mom reclined and baby floating prone.  Mom do lots of hand expression, reverse pressure softening or whatever would make nipple flexible into the shield.  

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Sunday, June 19, 2011 12:48 PM
Subject: large nipples and hyperactive gag

Looking for any further suggestions for mom with large diameter, somewhat flat nipples, very inelastic, hard nipple core and baby with very early, hypersensitive gag reflex which combined have made breastfeeding not possible for now.  Baby had posterior, lingual tongue-tie and upper, labial tie clipped which made bottle feeding with Haberman with shorter teat possible on day two.  Mom is using the cherry shaped German nipple shield and her nipples fit but do not extend very far into the shield.  Have tried the  larger
A---- brand shield but this gags baby so the more bulbous shield she is using is better as baby will latch and suck but then habituates.  Tried  filling the shield via curved tip syringe in hopes that she would continue to  suck once milk was gone from the shield but this didn't work, she stopped sucking.  Tried feeding tube under shield with syringe to give boluses but  baby only sucked the nipple part of the shield to get this milk and mom felt no drawing in of her nipple as she could when there was no milk in shield, though  those few drawing sucks did not produce milk transfer.  Baby cannot latch  to bare breast due to gag.
 
For gag de-sensitizing tried CW Genna's exercise and finger feeding with syringe and tubing so milk flow decreased gag but baby gagged and resisted both.  Have instructed mom to continue trying both of these and suggested CST from the beginning which I hope she'll follow through with.  I hope a tincture of time and baby's mouth growth will enable breastfeeding but this is for now a real oroboobular disproportion situation.  Mom has copious amounts of milk and is pumping and I've told her of another case where mom finger fed for about 3-4 wk until baby could handle her mom's large  nipples.  
She is discouraged so am offering frequent support, just wish I  could help get baby to breast sooner for mom's sake. This baby is 11 days old  now and thriving.
 
Would welcome any suggestions or info on similar cases.  Thank  you.
Barbara Latterner

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