>Date: Thu, 27 Jun 1996 19:33:35
>To: [log in to unmask]
>From: Managed Health Care <[log in to unmask]>
>Subject: Nipple confusion
>
>Dear Barbara
>
>I was SO pleased to see your thoughts on bottles/nipple confusion.  I
realize that challenging our old beliefs on this may be seditious, but I
have been forced to observe that babies can and do learn to breastfeed even
after bottles have been used for several weeks.  I suppose the scales fell
from my eyes about a year ago when a mother came with a two-week-old fully
breastmilk-fed-by-bottle baby who had NEVER (not even once!) been put to the
breast, exam showed baby's oral anatomy perfect, nipples perfectly normal
size/shape so we positioned in the football hold, I did the latching for her
(because she didn't believe that it could be done) and voila - baby sucked
for about 2O minutes perfectly competently, normal suck-rest pattern, lots
of swallowing.  Then Mum did it  while I watched and they went home
rejoicing.   Over Christmas I worked with a
>17 year old African mother, who'd had a 5-week prem baby, discharged at 4
days, now 5 weeks and l9% BELOW his birthweight - horrendous, emaciated,
government system, weekend, under NO medical care - long story.  Anyway by
some miracle mother had been expressing (and discarding milk!) so had good
supply.  The concerned citizen who called me had already provided her with a
bottle and the baby was too weak to drink in any other way so we took it
from there.  He picked up gram by gram and then started taking 22Oml/kg and
gaining 7Og per day.  It took him 5 weeks before he learned to breastfeed,
but this couple did it.  My heart was in my mouth because this was a very
poor mother, currently living in servant's quarters in smart area of town,
with access to fridge etc. but about to go home to very squalid conditions,
no fridge, no money for bottles, certainly not enough for formula (current
cost almost lOO% "minimum wage").
>I had to be VERY careful about positioning and technique, and VERY
repetitive, but she did it - and I'm convinced that it didn't really come
right until THE BABY was strong enough.  At this time his weight on the
chart I'd plotted just happened to coincide with the weight I'd computed he
SHOULD be if he'd gained at a "normal" healthy rate.  I've also worked with
mothers who've breastfed, given supplements by bottle and attempted to
return to breastfeeding again too soon, for fear of nipple-confusion, so
that the baby goes backwards again - maddening.
>I'm so glad that you have opened this topic up to debate - and I hope to
see more opinions.  I have also heard mothers say they want to give either
breast or bottle and are not prepared to do both - I too sometimes wonder if
the fear of nipple confusion (or the belief that it is inevitable) forces
them into an either-or situation.  It sometimes seems to me that
bottle-feeding is not the issue - making breastfeeding possible, easy, and
effective is what is important. And I agree that the original problem needs
to be addressed first - bottle-feeding can be a symptom, rather than the
only problem. Sometimes I think a bottle can even be used as a tool to
facilitate breastfeeding by providing a very quick, very easy way to get the
milk into the baby thus causing him to gain weight faster and become strong
enough to breastfeed sooner.  So very much depends on what the mother's
motivation to breastfeed is.  I do not ever SUGGEST bottles but if she gets
impatient or depressed about how long it takes to spoon or cup or fingerfeed
then I do let her know that she CAN just FEED the baby now and work on
getting him back to the breast tomorrow, or next week, or when she's ready -
and I present it as GRADUALLY teaching the baby how to breastfeed - when
everyone is less stressed - a bit like a "time-out" for now and a process
later. It works.
>
>I remain fascinated by latching difficulties - the most challenging part of
being an LC for me and the most rewarding when it comes right!!   Thank you
again for your thoughts on this.  My unease about nipple confusion started
out as the tiniest suspicion, based on observation, but I'm becoming more
and more convinced that it's an area that needs to be really explored in depth.
>Any thoughts on nipple shields while we're at it ....?
>
>Pamela, Zim
>