Hi Linda,
When mom has very large nipples, they usually compete favorably with the
bottle (in terms of stimulus), as long as we can maintain her milk
supply.  I usually recommend such a woman breastfeed with the best
asymmetrical latch she can get to maximize baby's intake, and then
supplement with pumped milk.  If the baby cannot move much milk at all,
she might need to bottle feed and bf a few times a day for practice.  If
the baby is getting milk, but not enough to grow, she might pump after
feedings and give a few bottles or fingerfeedings a day to make up the
calories.  She often needs a lot of reassurance, and concrete help in
determining the adequacy of baby's intake at breast so she can calibrate
her pumping and supplementing accordingly.  Once the baby's mouth grows
sufficiently (usually 3-6 weeks), they usually transition well to
exclusive bf.

The babies who have not learned are often the ones who "get it" with
some skin to skin, or spoon feeds of colostrum so they know what they
are looking for (and don't get hypoglycemic or too weak to bother
eating).  Pushing the right buttons for these babies can be helpful :
getting their bodies wrapped around mom, their chest on mom's chest,
chin on the breast, and nipple just above the upper lip often gets them
looking for the nipple and latching.  The chin on the breast seems to be
the last magical step - babies who are crying like they have no idea
where the nipple is start to orient correctly the instant the chin makes
contact.  I have some neat video of a 1 month old baby's first latch
ever (had bottle fed ebm since birth) that I've started including in
most of my presentations.  He's crying and complaining, until his chin
touches the breast, then he immediately orients and latches.  He comes
off and does this a few times, to let us know it is not a fluke!

And don't underestimate the power of modeling calm confidence to the
mother.  As long as mom is helped to bring in and maintain a milk
supply, the door is open for her baby to learn to bf.

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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