Hi. I have been working in a hospital for 3 months now and have experienced
problems with large, rounded breasts and flat nipples.  The nurses see a
lot of this too.  I did a search of the archives and found a lot of helpful
posts, but I do have some questions.

First of all the nipples are not just flat, they are short and inelastic. I
have read a lot here about epidurals, pitocin, and IV fluids attributing to
flat nipples. I plan to explore this area more. I read about RPS and I will
have to try it.

I realize that babies can nurse on flat nipples and the real trick is
getting enough breast into the mouth. When I try to help these babies latch
I use the breast sandwich. On more "normal" breasts this works great, but
with these larger breasts it does not seem to work as well. Baby gets their
mouth over the thinned part of breast, but this stil does not place enough
breast tissue far enough in the mouth to stimulate sucking. I feel like I
need an extra hand to shape the areola from all sides to make it fit in
baby's mouth not just bottom to top lip, but from the corners of the mouth
too. Does this make sense?  I almost wish I could put a band behind the
areola and tighten it enough to, in a sense, make a smaller breast out of
the larger breast!  I know this isn't realistic, but I am just trying to
convey my thoughts, which is hard to do via email!

These babies suck well with finger feeding, pacifier, and nipple shield so
I know if we could just get the breast tissue far enough in the mouth and
keep it there until baby starts sucking well, we would be okay--I think! It
is just so frustrating to watch a baby try to latch onto these breasts and
act like they do not know what to do with it.  Why does the suck stimulus
have to be so far back in the baby's mouth anyway?

Thanks for listening and for any comments or suggestions.

Christine Lichte LLL Leader, CBE, 2003 IBCLC candidate

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