<"I need some help other than my "opinion" regarding  a practice that is
being done by a night shift newborn nursery nurse.  I need any
documentation from articles, books, and opinions, that this is not an
appropriate action.
Here goes!
Is it appropriate to place a bottle nipple over a mother's nipple to
assist with latch on?
Thank you for you response.">

This was an old "makeshift" practice used many years ago (50) on our OB
ward if there were not commercial nipple shields available (the old type
with glass/plastic bases with rubber nipple attached, or the thicker
one-piece rubber shields with 'ribs' inside the nipple. Perhaps someone
is doing it in order to avoid a cost item. It seems to me it could have
some of the same 'confusing aspect' that a bottle nipple on a bottle
might, but without the flow-rate confusion of the flood of fluid
resulting.

That said, however, if the baby will suck on it, it is a gentle way for
the baby to 'pull the nipple out', much gentler than the use of an
electric breast pump to prepare the areola for latching. The nurse is at
least trying to be helpful without expense and trauma to the mom or ABM
to the baby. By the second night, mothers who may have received a lot of
IV fluid and/or pitocin might well be beginning to have an excess of
interstitial fluid under the areola, even if it is not yet visible as
edema. This creates excess subareolar tissue resistance to latching.

I have found that cutting off all but the last 1/4 inch off of a standard
rubber nipple, leaving mainly the collar of the nipple, allows
observation of the mother's skin color when it is put over the mother's
nipple for her or the professional to press on in doing Reverse Pressure
Softening for three or more minutes, or as long as it takes. (If the
mother's nipple is relatively small and the periods of pressure limited
to 3 minutes between inspections of the skin color, there would probably
be no real need to cut the rubber nipple off.)

This is a very effective way to soften the areola prior to latching,
reducing excess subareolar tissue resistance, and triggering the MER in
the process. (It is then removed for latching attempts, of course!) For
more info on RPS, you may wish to read:
Cotterman, KJ, Too swollen to latch on?: try Reverse Pressure Softening
first, Leaven Apr. May 2003, pp. 38-40.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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