i am hoping to garner some ideas from anyone with more experience with this issue. i've seen a mom today, 5 days post partum c/sec w/ dd #2. she called me describing cracked nipples and pain with nursing. she also felt she "is one of those women who can't make a full supply" and is already supplementing with formula so her baby "doesn't starve". apparently she had supply issues after the 1st c/sec and immediate supplementation (big surprise) and now feels certain she is not capable of making a full supply. hubby is also hypervigilant lest any overzealous lactation professional try to convince them to starve their baby again. i had my work cut out for me - this i knew. 

i fully expected to walk into a nipple confusion or tongue tie scenario. imagine my surprise to find one of the most beautiful and perfectly formed baby girl mouths i've ever encountered 5 days pp. she sucked w/ perfect rhythm and motion - not a hint of nipple confusion. her tongue went at least 3/4" past her lip and i found absolutely no ankylglossia upon examination. her latch was flawless. the problem is that mom has the most enormously bulbous nipples i have ever seen. they are quite literally shaped like lightbulbs. the baby tried valiantly time after time to latch - and truly, there was never a baby more suited to this mother's anatomy - she opened HUGE when trying to latch -  but she simply could not maintain the latch. it was like she just didn't know what to do with so very much nipple. if you put your 2 thumbnails together, back to back - her nipples were bigger than that. closer to 3 thumb tips.
i've encountered a good share of bulbous nipples, but nothing like this. 

mother reports that they really change during pregnancy and are more normal otherwise. they were both cracked at the tips, but not as badly as i'd feared. she appears to be a really fast healer based on the fact that she'd reported pumping almost all blood the day before i saw her and repeated attempts at latching and nursing did not cause bleeding when i was there today. she has one bleb/skin tag on the right nipple, as well. her breasts seem completely normal otherwise and went through normal lactogenesis. she had engorgement on days 3 and 4 which we relieved with reverse pressure softening w/ marked improvement. she leaked milk appropriately and baby tried to maintain latch repeatedly over the 2 hrs i spent with them, to no avail.

we tried every position in the book - even mom leaning over baby and dangling the breast into baby's mouth to see if gravity helped the flow and kept baby interested - but it's really like it's just way too much for baby -she latches on and then rejects it when it's too much for her to suck into the proper shape. she was born 4 days past 40 wks and is 8 1/2 lbs, so not an overly tiny baby. i encouraged mom profusely, telling her that a more perfect baby couldn't have been born to her slightly overachieving nipples. it is my hope that baby will "grow into them" and my job is to help stave off nipple confusion and keep baby and mom doing as much latching and skin to skin as possible until then, while offering info and support for alternatives to bottles and paced bottle feeding.

anybody have any tips or experience with this issue that can help? thank you for your time and consideration!
~jacqui gruttadauria, bsw
(near detroit, michigan, where i hate leaving a client's house feeling like i really wasn't able to help much!!)

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