I would appreciate some advice regarding this client. Baby latched on could suckle few sucks and kept losing the breast.
Applied 20mm nipple shield which seemed to fit well. Nipple was blanched at the top but not the bottom. Removed the shield and tried 24mm shield. Less blanching but still some. 24mm was a better fit. R breast able to latch without nipple shield, Good latch, suckled well and not losing the breast. When baby came off still some blanching but not like with the shield. Mom has cracked nipple on right. L nipple intact but tender. She delivered on Saturday. I saw her today before discharge. She was given the shield by the staff nurse in her care. Baby has a slight arch in palate but not that high.
She has good tongue movement and can stretch her tongue out well past her lips. Mom's breast are starting to fill. Nipples are short but erect. Areola sl firm but R side is more pliable. 
Any suggestions would be appreciated.
Thanks,
Terri Klein RN, IBCLC, RLC
One more question but related to this. I am recertifying this year by Cerps. The information is out by ILCA but I cannot find anywhere how much it costs. Is it the same as the exam? Thank you.

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome