Hi Leslie,
I would certainly try RPS if mother is willing, just gently
manipulating the nipple to stand out some as well, and then try a
biological nurturing position (laid back bf) and/or side lying
position. I am often successful with this type of breast tissue by
pinching or lifting a little of the nipple/areola and sort of placing
it/laying it onto /into baby's tongue/mouth when the baby gapes
widely, and actually holding it there *momentarily* until baby has
drawn enough in to hold the attachment.
Unfortunately this is one of those times where mother feels you must
go home with her in order to achieve a latch, but once mom and baby
get it a few times, it usually goes along fine w/o help.
Remember to do the RPS (or have mother do) with mother supine if
possible, as gravity will assist with things, and also to do the RPS
for at least a full minute if not longer.
I would actually try all this w/o a shield to see if it worked.
Also, mother may need to support her soft, pillowy breasts (I call
them fluffy) on a small pillow or other support. Also I like to let
the breasts fall where they will naturally and not try to move them
around in an unnatural way.
Hope some of this helps.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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