>From: Ann Marie <[log in to unmask]>
>Reply-To: Lactation Information and Discussion
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Help needed: "doorknob nipples" + babe with small mouth
>Date: Tue, 6 Aug 2002 18:10:18 -0700
>
>My colleagues contacted me today for help on this case, and asked me to ask
>all of you for help.
>Ann Marie Henninger
>
>Primip, Asian mom with doornob nipple directly attached to breast, the
>scant
>amount of areola disappears with erectile tissue response.
>Babe w/ very small mouth unable to open wide and when able to latch gets
>only doorknob nipple, unable to get near diappearing areola.
>
>Low milk supply issues, working on getting double pump.... mom purchased
>avent for travel home to Korea....  will consider
>option for Reglan with midwife.....we need any other ideas?
>Glover /assymetrical latch doesn't work when not enough breast to create
>bulge and babe not managing to open wide open mouth to go over nipple.
>
>Thanks in advance for any help on behalf of my cohorts who are not
>LACTNETTERS.
>Ann Marie Henninger, RN, BSN, eagerly waiting for October 11th
>
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I recently had a very similar case, mom also Asian. Mom continued to
struggle with low supply for awhile, but was very compliant with her need to
feed frequently and worked very hard to maintain breastfeeding. In my
thirteen years of practice she was in my top 3 moms with the largest nipples
I've seen. Interesting though that as I met with her for a final weight
check at about 3 weeks postpartum her nipple size had decreased slightly and
she was nursing much more comfortably. Initially, I suspect her nipples were
approximately 1- 1/4 inches in diameter with a 1" shaft and very tense.
Luckily she had a very patient baby who really learned just how wide he had
to open VERY quickly. She did do some addtional pumping the first week or
sofor good stimulation.

This particular mom used an Avent ISIS for some engorgment too - as she was
going to be a stay at home mom. We were able to establsih it  that the
flange base was " large enough" ( I think larger than Medela's average
flange. I was surprised and happy to see a smaller nipple after a few weeks.
so perhaps this will happen to your client as well......

LuAnn Smith, IBCLC
In PA


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