Jan,

Sounds like a logical conclusion that baby doesn't have to suck as hard
with SNS.

Have you tried having the mother trigger her MER by hand expression  just
prior to latching? This would accomplish at least 2 things: The milk
would be immediately available in quantity to the baby, mimicking the
immediate gratification it gets when the SNS is used and therefore not
requiring the increased vigor in suckling. It would also soften the milk
reservoirs so that the areola could be drawn further in, thus putting the
tip of the nipple nearer the soft palate. It also might help for her to
massage the breast during the feeding as suggested by Dr. Newman.

Keep us posted.

K. Jean Cotterman RNC IBCLC
Dayton, Ohio
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