Dear Lactnetters,
Several months ago, before I was on LactNet myself, another LC posted my
problem for me.  A mother with firm nipples that measured 1" long and 1" in
diameter.  Baby was 3 weeks old and not gaining weight without supplemented
expressed breastmilk.  Mother had nursed two babies before without a problem.
 This baby's palate was 1-1.25"long.  Mother's milk sinuses were another 0.5"
behind the nipple base.  I determined that baby was unable to effectively
milk the breast and would need to grow before she could.

At that point my question was, how long until this baby could be expected to
breastfeed effectively?  I want to thank those of you who responded with your
suggestions and let you know what has happened thus far.  Baby is now going
on 4 months.  Mother has pumped and bottlefed while continuing to offer the
breast several times a day.  At age 3 months, mother offered only the breast
for 24 hours, which led to breast refusal that I attributed to baby's way of
saying, "I'm not getting full this way."  Baby will still take the breast,
but mother is no longer offering it every day. Her hope is waning.  Mother
finds it difficult to continue to see baby not taking the full feed even
though the milk is there.  Mother continues to feed exclusively breastmilk
while grieving the loss of feeding at breast full time.  She is satisfied
enough with the way things are.  (Yes, we tried prone positions, etc.  An sns
at breast was also tried, but mother chose not to continue using it since
baby continues to take the breast when offered and that was enough for mom's
satisfaction.)

Were mother interested or if I thought it would really make a difference, I
would see her again to confirm that positioning and latch-on are not the only
problem. (If I get lots of private email messages of success stories I will
encourage her more!)  I did note with interest that mother commented that
both of her first 2 babies needed a lot of comfort sucking at the breast,
unlike this baby who only sucks to drink milk....hmmm.  Maybe the other
babies needed to really work for their food too!  (I didn't say anything to
mother since she feels so good about those experiences).  It also made me
wonder if the phenomina of so called meaty nipples is occurring.  Is it true
that they do indeed become thicker and more difficult to milk with each
pregnancy?  Just wondering.  I don't suppose there is any research on that
yet...

When I sent in my question before about how long until baby can effectively
breastfeed, I received no answers, only management help which confirmed we
were on the right track.  Do the others end up choosing like this mother, not
to pursue it?  Are there too few cases to do any research on this?  sigh...
 The fun of this job is the endless stream of new questions and challenges.
 The difficulty is the need for more researched based answers!  However, I
would love to hear related clinical experiences as well and will use what I
can get!  Any more ideas would be welcome.

Natalie J. Shenk, BS IBCLC
Private Practice LC in Findlay, Ohio, USA