Paula, I hear you!  And I know you have our collective support.  We all have
bad days when everything we try for one mom/baby pair seems not to work.
Don't despair, remember when you tried a particular technique for another
baby and it *did* work?  When it's a case of flat nipples that compress into
the breast, especially if the mom has firm, inelastic skin, then truly, with
the best will in the world, and all your latching skills, (it's not *you*!)
ultimately there are some anatomy things that have to be accepted - this is
what I tell myself on *my* bad days anyway!  If this was my client I'd heave
a large inward sigh and think about a nipple shield, for several reasons -
to ease the transition from bottle to breast, to reduce the amount of time
the mom has to pump, to make breastfeeding (at the *breast*) possible, to
help stretch that inelastic tissue. After a few days of successful
breastfeeding with the shield (or even a week or two) then I'd try the baby
without and see what happens.

I've never used an SNS so I'm only imagining here, but logic would dictate
that if the baby can't *latch* then the baby can't *suck* - with or without
an SNS, p/syringe or whatever and that if the breasts are already producing
a good supply then providing additional milk via an SNS is not what's needed
anyway.  Sounds to me like you've done your best with what there is, and if
breastfeeding is just not happening then a shield could be used in good
conscience, as a last resort.  In the meantime, if the mom is feeling
overwhelmed and has to pump and provide EBM for a few days to give herself a
breather, then so be it - maintaining the supply is the most important thing
IMO, while there's milk, there's hope!

One question, could you describe (in detail, please!) what "flipping the
nipples" is?  Thanks.  And keep on, keeping on!  On my bad days, I find
Lactnet so sooooothing!

Pamela, Zimbabwe