Hi  Anne

I have found that a baby with a very high and narrow palate is one of the
very few situations where a correctly fitted type of nipple sheild can be
invaluable.  Perhaps this is why the baby was given one in hospital?  The
sheild allows the baby to take enough of the breast into his mouth, and to
enable the mothers nipple to reach the junction of the hard and soft palate
in his mouth, thereby ensuring a correct suckling action.  Very often a
baby with a very high, or scoop palate will take the breast into his mouth
and the nipple will slip up into the "scoop".  The baby looks as if he is
attached beautifully, but the breast cannot be milked properly.  In some
mums this also presents with the nipples being abraided at the tips,
because the nipple is rubbing on the hard palate.  The baby usually doesn't
gain weight "as expected" (unless the mum has a forceful MER initially).

I also find that the use of the sheild for a few weeks, and using a
modified "football" hold (ie....the baby held under the mother's arm - same
side he is feeding from - but sitting upright to face the breast, with his
mouth at the level of the mum's nipple), is really good.  It is a position
where the mum can see exactly what is happening as the baby attaches - she
just needs to ensure that enough of the underside of the breast is going
into the baby's mouth.

Some mum's use the nipple sheild to "force" the nipple into the baby's
mouth, so that the baby doesn't know he has to have a nice wide open mouth
when attaching.  These mum's need to be advised to feed the baby exactly as
if they weren't using a sheild, and make sure the mouth is wide, etc.

I realise that I am "diving" right in there as regards the use of the
nipple sheild, but like some other lactnetters who have written regarding
sheilds recently, I have found in some situations where nothing else works,
sheilds to be really helpful.  I would rather see a baby happily nursing at
a mothers breast through a sheild, leading on to an extended nursing
period, than a frustrated mother giving up breastfeeding altogether, or in
a totally un-natural situation where she is expressing and feeding by
bottle.  Is not one of the advantages of breastfeeding the developmental
changes in the baby's mouth through the muscles used to milk the breast?

Hope this gives food for thought Anne, and doesn't stir up too much of a
hornet's nest!!

Brenda Donnelly
Brisbane,   Australia