Pat,
As I was reading your post I found myself thinking "This might be a
valid case for a nipple shield."  I have found some cases where baby
is "doing something funky with its tongue" and we have been unable
to get it corrected, that the firmer consistency of a shield is just
enough to keep baby from "misbehaving" with the tongue.  The fact
that the nipple/areola is more pliable makes it easier for baby's
tongue to pull up even with a deep asymetric latch.

My concern was when you said, "I left her with a nipple shield and
instructions on
how to use to see if it would help the pain, at least on the left
side."  Did she try the shield when you were present?  I would
certainly prefer it this way for several reasons:
 1- You can see for yourself whether it is making a difference.
 2- You can be sure she is applying it correctly. (Inverting it
partway bdfore applying so you start with more breast tissue inside
the "nipple" portion of the shield.)
 3- If she tries it on her own and feels no difference, it may be
the last straw so she gives up and you won't know whether it didn't
work because it wasn't the answer or she wasn't using it
effectively.

These cases where we've tried the "A" list, gone to the "B" list and
then are clutching at straws can be frustrating.  When I get to the
point of suggesting approaches that are uncommen or even untried for
the particular situation at hand, I frankly tell the mom that since
none of the more common suggestions have helped, I am reaching for
an uncommon solution.  Breastfeeding is not an exact science and
each situation has it's own uniqueness.  While offering suggestions
"from left field" is not evidence based, we sometimes have no choice
and as professionals, we need to be honest with our clients when we
reach this point.  I have found moms very accepting of this approach
and they will get back to me to let me know whether or not the
"offbase" suggestion made any difference.

Winnie

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