Denny, you wrote, "She has small breasts, but extremely long narrow nipples.
By the time baby has all the nipple in, there's no chance of getting all the
way to the areola.  She tried a nipple shield w/o success (the nipple filled
up the shield
and "squashed" to get all of it in, causing the milk to be trapped.  She can
only pump 2 oz with a double electric pump, but gets 4 with the Avent.
Apparently the "petals" are able to put pressure on the areola.  Also, the
electric double pump is very painful to her.  I would welcome any ideas or
suggestions to help this mom.  My colleague describes the mom's nipples as
being almost like a limp rope and over 1 inch long. (2.54cm). Baby is very
petite, tiny mouth, just like #1 and mom. "

Have this mom tried Medela's glass shield for pumping?  I've used this on
occasion for mom's with wide or long nipples or deep "sinuses" with good
success and mom's are able to get more milk with comfort in less time than
Isis.  Have found these moms can't comfortably use large or extra large
shields either.  It sounds like this mom may have to express her milk for
awhile until baby's mouth enlarges so Haberman with it's long nipple and
regulated flow might be helpful, also.  Direct breastfeeding might work if
she can compress "sinuses" manually without disturbing latch  or use breast
compression ala Jack Newman.

It must be disappointing to this mom to not be able to breastfeed now so lots
of skin to skin, etc and ongoing support and re-eval essential.

Barbara Latterner, BSN, RN, IBCLC
Brewster, NY


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