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From:
laurie wheeler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 29 Jan 2007 04:08:06 +0000
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Hi Jennifer,
As I was reading this, I was thinking with cases like this, when do we say "enough." I do believe this baby can eventually breastfeed but it seems it may take awhile. I would first acknowledge to mother that this is a very difficult situation, acknowledge her pain, her perserverance, her committment to breastfeeding, as I'm sure you have already done. Then I would state that the road to full breastfeeding may take some time, and what does mother feel she can handle and is her patience still holding. 
My idea would be to find a good nipple for paced bottle feeding, I personally don't like the Avent because I think the baby has a hard time flanging on its very wide base, I prefer one that is more tapered to the base rather than the abrupt change from narrow to wide that I see on the Avent. I don't have a preferred nipple brand but I look for softer, slow flow nipples that taper to the base. I personaly don't like finger feeding (unless for a very short time like 24 hrs or less) because it is awkward and doesn't seem "normal" for mom.
Then I would allow a period of nipple rest with pumping 8-10x per day with a hospital grade double electric pump. I would encourage lots of skin to skin and pleasant exposure to the breast but not the nipple right now. I would later transition baby to breast with a nipple shield. I would work on baby's sucking skills via bottle, because I think otherwise would continue to damage the nipples. Use whatever you like for nipple healing, I usually recommend warm soap and water gentle washes a couple or three times per day and air dry, and a thin application of antibiotic ointment. She may need a mild pain pill or anti-inflammatory analgesic for a time. 
I think that this baby has some anatomical issues that are not going to automatically resolve and I believe "A baby who won't latch, can't latch, and a baby  who won't breastfeed, can't breastfeed" applies to him. 
If you are able to occasionally watch him feed on bottle, and see he is improving, then you can try to return him to breast. You've already noticed that applying some downward pressure (I think you said) is helpful. In my experience when bf is so hard and painful for mothers, and we are asking them to do many different things, they abandon their efforts; so I think a period of just joyfully feeding him by bottle, with her own milk, will be good for both of them.
I wish you all success.
Laurie Wheeler, RN, MN, IBCLC
MISSISSIPPI, USA
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