Kathy,
   With our extremely high epidural rates in East Texas, we see this alot.
Sleepy babies and flat nipples are my greatest frustration.  Have you seen
the nipple extractor made from a 30cc syringe?  This seems to work better
than shells for us.  We usually implement syringe/cup feeds of EBM of very
small amounts then move to dripping ebm on the nipple to encourage latchon.
  What we have found is that with facial massage, oral stimulation and lots
of patience, these babies come around in about 4-5 days.  I also wonder how
much of this can be attributed to scrambled brain cells from delivery?
                 Kellie Richardson