Karin,

If the only reason baby won't latch is lack of flow, I would suggest a
supplementer.

If baby is unwilling to breastfeed because she is also now used to the
flow and feel of a bottle nipple, several options exist.  I would go
with the one that is most comfortable for the mother and which the baby
will accept.

Option 1:  Nipple shield with supplementer tube under nipple.  This
works great for some mom who have a breast and nipple the right size,
shape and texture so that the shield stays in place without much fuss.
For other mothers it doesn't work at all--milk leaks out, shield keeps
coming off.  If you turn the shield half inside out (This works with
Medela shields, but not with Ameda shields.), set the shield on the
nipple, then stretch the edges of the shield so that more breast tissue
is pulled into the shield.

Option 2:  Substitute finger feeding for bottle feeding.  I tell moms
who are finger feeding that if they feel they must bottle feed a feeding
now and then, its ok, but encourage them to use a "fat" (Munchkin--must
use Munchkin or Playtex bottle; Avent--fits Avent bottles only; or Nuk
or Medela--fit standard thread bottles) slow-flow nipple and teach the
baby to suck on the large part of the nipple.  I find that most moms
(and dads) quickly tire of finger feeding.

Question:  Which tubes and how many (one or two) on a supplementer do
you use for finger feeding?  I'm assuming it usually varies with the
situation, but what do you start with?  I have been using one
medium-sized tube, but recently saw that someone was recommending the
two large tubes.  With one medium tube, it often takes a newborn 30-45
minutes to finish a feeding.  This is similar to the time for a breast
feeding, but much slower than cup or bottle feeding, which may be why
many moms are unwilling to do it for long (more than a few feedings).

Option 3:  Just switch bottle nipples to the fat, slow-flow variety.

Option 4:  Cup feed the baby.

For some additional pros and cons of the above methods, see my article
in Consultant's Corner in the September 1998 JHL or e-mail me privately.

In the meantime, mom needs to do lots of skin-to-skin, co-bathing, carry
the baby in a sling, and make the breast available without forcing the
issue.  Unless it is too painful, she could even allow baby to suck at
the breast with a less than perfect latch for short periods at the
beginning if baby is happy doing so.

Help mom to realize that the options above are transitional techniques,
and continue to praise her for her all-important efforts to provide her
baby with her own milk.  As Dr. Jack has suggested, banked milk would
also be a great adjunct.

Bonnie Jones, RN, ICCE, IBCLC