I agree with Jean in the laid back positioning for these bulbous nipples.  I
have had several moms with large bulbous nipples whose babies aren't gaining
well and I believe it is because they have such large nipples that the baby
just pretty much sucks on them like a pacifier and doesn't stimulate the
glandular tissue behind the nipple any, thus leaning back would pretty much
force the deeper latch to occur.  

 

However . if the nipple is too large, this could force too much nipple into
the baby's mouth and cause the gag reflex to occur.  That is when I would
try the 24mm nipple shield and see if enough of it could fit into the shield
and protect the baby from the size.  Baby would still need to be on top of
the breast (mom laying back quite a bit) and so making sure baby was in
exaggerated "sniff" position to keep airway clear of breast tissue would be
important.  Depending on the fit of the nipple into the shield, the amount
of breastmilk obtained might be quite compromised, so the parents would
still need to pump and give the baby supplemental feedings, but they could
at least enjoy some breastfeeding!  

 

I have had one mom who had to pump until her baby got bigger and could
"handle" the size of her nipples.  In that case, I would encourage the
parents to shop for the largest bottle nipple made so that it will be as
similar to mom's anatomy as possible.  (probably a latex - like orthodontic
shaped nipple.  I know I have seen these in pacifier form, not too sure
about bottle nipples tho)  The parents will need to know they are pumping to
protect their supply until baby can manage the nipple better and know how to
"pace" the bottle feeding per chance this bottle nipple size only comes in
faster flow options.  

 

Linda Hill RN, IBCLC

 


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