>        I'd like to hear how other people deal with moms with larger breasts
>with large areola and flat (not inverting upon compression, but VERY flat)
>nipples that the baby can latch onto briefly then fusses and cries and lets
>go in a minute or two at the most.
>        Positions for best latch on? Frustration level in baby? in mom?
>using a pump and supplemental feeding techniques? how long should she keep
>trying at each feed? what about nipple soreness from repeated missed
>attempts? will the baby "grow into" these nipples? should she pump to
>establish milk supply? what supplemental feeding techniques would help most
>here? are there flat nipple cases that simply never work out? is
>perservernce going to pay off in the next couple of weeks?
>        I've seen a few of these cases this year and wonder what else I can
>be doing for these moms... some I know succeeded, other's I've never heard
>from again...I've got a two day old baby with no wet diapers in 12 hours
>waiting for your solutions!!

Anne,
This is very early days (2 d.o.) to start thinking about whether
breastfeeding is going to work or not. To answer some of your questions,
she should keep trying only as long as it is not too stressful on either
her or baby. Once either or both are distressed, further attempts are
usually counterproductive. We need to be gentle and avoid rough attempts to
attach baby - you know, no 'ramming'). Yes, she should express (better by
hand until milk comes in - eg hand express colostrum onto a clean spoon and
offer to baby). Model patience - 'It may take a little while, but we'll get
there', give mum confidence that she and baby will be able to do this -
'See, he knows what to do, but is finding it a lot of effort to stay there.
He will get better at it', etc. Keep baby fed (whatever that takes, even if
it means using formula), and establish milk supply as best you can. Worry
about getting baby to attach perfectly later, if necessary.

Most likely baby *will* 'grow into' these nipples, especially if he is able
to attach briefly at this stage. Expressing will also help make the nipples
more protractile and easier for baby to grasp. If problem persists,
judicious use of a nipple shield may help, but preferably not in the first
few days. This would need to be introduced under competent supervision, to
ensure baby is attaching correctly to the shield and not just hanging off
the end and bottle-sucking. We need to make sure baby is actually getting a
good flow of milk through the shield. I have found that this often gives a
mother confidence to keep trying to attach baby to the bare breast, but if
it is not working, she has the shield close at hand to use so baby does not
get too upset. It takes the pressure off her each feed time. She can then
gradually work on weaning baby off the shield completely as he grows and
gains more strength in his suck. It also reduces the likelihood of baby
becoming 'addicted' to the feel of the shield if she can get him to feed
without it some of the time.

Joy



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Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
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