I'm not sure I believe in nipple confusion, but I certainly do believe in
*suck* confusion.  When I use the term suck confusion  with the parents
and the doctors, it seems somehow less threatening and more workable.
Perhaps I just take 'em off guard:  They're only programmed to react to
the nipple confusion tag!   Showing the normal sucking sequence at
breast (I use the Childbirth Graphics pics) and how a baby gets milk
from a bottle helps explain  what's going on inside baby's mouth.  In my
experience, once folks understand what's happening and why its happening,
they're ready to talk about fixing it.

I'm a *big* proponent of alternate feeding methods, but have also needed
the flexibility to accept parents who "needed" to use a bottle.

Using the Avent nipple or the one from J&J (that comes on that silly
angled bottle--now *that's* a hoot:  bottle feeders aren't capable of
holding the darned thing at an angle so the baby doesn't get air?!) seem
to create less of a problem than do the freebies that come from the abm
companies via the nursery.  Nuk and Pur are what I find work next best.
I personally have had numerous horrendous experiences with the Playtex
nipple but have heard some LCs say it works for their clients.

It's too bad we're so culturally oriented to "the bottle" so that other
feeding methods take so much explaining to win acceptance from parents,
doctors, nursery staff, etc.

In my practice, I see so many suck confused babies that I rejoice when I
have one that's not!  Often, there's no traceable reason why the baby is
a tongue huncher/sucker but I've *very* suspicious of epidurals and
postpartum pain relievers! Sometimes, though, an unmedicated birth has a
baby that won't suck nutritively at breast; I've seen a bunch of them
w/in 24 hours who have huge sucking blisters midline on the top lip!  I
tell the parents they must have developed a bad habit in utero (< big
grin>)  and go from there.

I try not to use gadgets (and talk myself out of a lot of pump
sales/rentals!) but I've found the real (not starter) SNS on my index
finger to apply pressure to unbunch that tongue is a real winner--never
had it fail, even with a few neurologically challenged babes.  Sometimes
the parents need to continue fingerfeeding for as long as the baby took
to develop the problem or at least until they don't feel him bunching
his tongue at all; then we transition to SNS at breast for a day or so
and then straight to breast.  It's fairly quick, gentle and effective;
babies who don't feed well at breast look so worried; you can see them
relax and enjoy once I've gotten their suck to work well.
The parents are *so* relieved that it's fixable and can see how to do it;
once the baby's going well, both mom and dad (plus any stray grandparents
who might be interested) are taught and try.  I've had mothers fingerfeed
with tears running down their cheeks; they'd though something was
horribly wrong with either themselves or the baby.  Dads are grateful
than mom is happy...and the baby is doing what he wanted to do but just
couldn't get the hang of, so everyone's happy.  The expresssions on the
babies'  faces are so peaceful and contented I get
teary-eyed too!

The primary concern is getting food in the baby.   Of course EBM is best,
but abm may be necessary.  (In an ironic twist, one ped partnership here
will *not* order abm unless the baby is near or at dehydration levels;
that's scary to me when these parents are my clients!  They seem to view
the abm as the antagonist, not how it's delivered to the baby.)

Of course, close follow-up is necessary, as these parents need an extra
measure of support.  But the SNS is portable (so long as the tubes are
flushed immediately after use!)  and fingerfeeding is do-able in
public--everyone wins!