Hi All,
I have some questions about this subject...and a comment to make about a mom
I saw yesterday.

The mom called initially because of diffliculty in latching baby (9 days
old).  Baby had lost almost 15% of bw and mom reported that her milk supply
was way down.  She had rented a hospital grade pump and was going to start
pumping.  She had gone through engorgment on day 3 or so and baby was
getting more sleepy and cranky - dark circles under her eyes, minimal
output.

When she latched baby I saw that mom had large meaty nipples - baby L-O and
started 'chewing' on the breast.  It appeared ot me that she was trying to
suck appropriately, but couldn't.  She got more and more frustrated - even
with an apparently deep latch - she kept 'chewing' - jaw moving straight up
and down.  Finally, I said - stop.  Baby was really frustrated - I thought
maybe there is some serious tight muscle stuff going on in this kiddo - but
I couldn't really feel anything (and I know what to feel for).  So mom
started feeding baby by bottle.  Baby had beautiful jaw movement - great
suck swallow coordination, great rhythm.  The only thing I could come up
with was baby's mouth was too small for moms large, thick, meaty nipple and
she couldn't get it where it needed to be to be able to compress the milk
sinuses appropriately.  Mom needed to get the 30mm size shields for pumping
because the standard size was way too tight.  So we have some grow time
needed here.  Mom asked about a nipple shield - I can garauntee that the
Medela newborn small shield would have never come close to fitting over
those nipples and I strongly doubt that the newborn regular would either.
Not that a shield would have helped in this situation anyway but we are
talking about shield sizes...
So my question is:  When we are talking about using the small nipple shield
are we talking the newborn small or the newborn regular and is there on that
is larger than the newborn regular??  If there is, I haven't heard about it.
And, when assessing the proper size shield to use (when it is needed) how do
we do that without taking the shield out of the package and 'trying it on'
for size?  Do we need to carry a small ruler with us too?  Or is this where
we get really good at 'eyeing' the size?  I have also been told that using
the newborn small is not the best idea as using the newborn regular will
give greater flexibility and fits most moms just fine.  Obviously if I have
a mom with tiny diameter nipples who needs a shield I would go for the
newborn small - but as a general rule I have been told that the newborn
regular is the way to go.

Comments??  Answers??  Thanks in advance!

Jaye

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