Christine
I do see this fairly often. I wonder about the problems of obesity, as most
moms with very large breasts are also quite overweight and even obese and I
think this might change the whole shape of the areolar/nipple complex. I am
not trying to be flip or insensitive, but obesity is a major health problem
and makes positioning, mobility, and latching quite difficult at times.
Here are some things I do to facilitate a latch:
Excellent positioning of course, have mom sit up as upright as possible and
use pillows for support. You must search and read all you can about RPS as
it is an invaluable aid; you must do the reverse pressure for a few minutes,
not seconds. Teach mom to do this as well. RPS usually results in a much
more latchable areola, helps the nipple protrude more, and almost always
yields large droplets of colostrum which baby can lick and target towards.
You should also search our archives and read about "teacup" hold; I think
Pamela Morrison had some good posts on that. From my understanding of this
(at least what I do) is to sort of pinch (almost like the last part of a
hand expression) the areola right behind the nipple (after softening up w/
RPS) and when baby gapes wide, then sort of 'place' the nipple/areola far
back so when he closes he latches and the nipple hits the S spot. Sometimes
you have to have some milk in a syringe or feeding tube to entice baby to
start or keep on sucking after the latch occurs. Sometimes when baby is
getting frantic I stop to calm him of course but even have resorted to
giving a few sucks on pacifier, finger, or even bottle (no flames please)
for babies who are getting regular bottles. If you do this, have baby in bf
position (usually clutch position works best) give the few sucks and try
again for the latch. It seems to show baby it is feeding time and of course
he is used to a bottle, but then he latches to the breast. Good luck.
One more thing: once baby 'gets' it, it must be impressed upon mother to
keep him bf, don't give him back to the nsy for the night feeds - please!

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA




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