Dear all:

I will repeat again that I do not use Haberman bottles often -- only for specific targeted purposes. When I first started using them, I overused them until I felt comfortable with what was appropriate and inappropriate use for my clients.

To date, I have NEVER had a client complain about INCREASED compression when her baby is feeding from the breast after using a Haberman bottle.  In fact, in the vast majority of cases I have seen, babies shift from using their gums to compress to using their tongue more appropriately.  At worst, I have had babies who just simply don't improve with the Haberman and these are the babies who really do badly with just about any artificial device.  

In sitting in on a couple of  conferences that Cathy Genna suggested that were by speech language pathologist, my SPECULATIVE theory is that the Haberman assists some baby's with central grooving.  There are some babies for whom speech language pathologists will use a narrow teat to promote central grooving.  This actually improves a baby's ability to remove milk.  If the teat is too fat, sometimes baby's cannot do this -- at least according to what I understood from their work.  

I have no explanation for the final observation that most babies will open their mouths just fine for the breast even though they have been on the skinny Haberman nipple.

It could be that I am intuitively screening out those babies who would do poorly on the Haberman, since I don't use it that often. 

In any case, the book that recommends the Haberman for all breastfed babies has a lot more advice that can interfere with breastfeeding than just that one particular blanket recommendation.

Finally, it helps to talk to colleagues about differences in practices and use of devices.  Sometimes new ideas can be generated from such discussions.  I know I've shifted to considering the use of some tools and diminishing the use of others.  I was trained initially to never ever use a nipple shield.  Now I use them judiciously.  I used to use the tube on the breast for supplementing babies over all other devices.  Now I use a much wider array of tools.  When someone uses a tool I hardly ever use, I figure they may have developed some technique that makes that tool work better for their clients and I might benefit from applying that new technique.

Best regards, 

Susan E. Burger, MHS, PhD, IBCLC

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