Thanks so much for all the great comments and encouragement.  My previous
post was so lengthy that I had omitted some details.

I gave mom a nipple shield at the first office visit.  (Baby M was 5 days
old)  She was able to achieve a pain free latch with help positioning and
redirecting the baby's hands (grabbing the breast and nipple) and feet,
kicking against Mom's incision.  She stayed at the breast for less than 5
minutes and the amount of milk she took was not measurable but it was the
best baby M had done so far and it felt like a victory. She left the office
that day planning to nurse first then give supplement as needed.

At home mom wasn't able to get baby to latch with the shield, mostly due to
the baby clawing at the breast and raking it off.  (I suggested she could
use a small bit of lanolin to help it adhere but the deeper issue is the
baby's ravenous hunger after a 6 hour sleep).

When I saw them on Tuesday mom was weepy, feeling drained and blaming
herself. Mom seemed to feel ashamed that she had given the bottle.  I
assured her that rule one is "feed the baby."  She has very gentle,
connected behavior with her baby and I gave her praise for that.

I suggested she give all supplement by bottle, practice skin to skin, and
take a bath with the baby.  Yes, this baby was taking up to 6 oz. at her 4
feedings in 24 hours and only occasionally having a small spit up.  I was
amazed, having never thought that amount would stay down in a newborn.

One remark I received privately was to try an Ameda shield as opposed to the
Medela shield we tried.  The suggestion is that Ameda's shield is firmer and
preferred by some babies.

She's getting older, closer to her due date.  Perhaps on Friday she'll be
easier to wake.  I've been thinking about the "Dancer Hand" position to
support that receding chin. I wish I'd thought of that on Tuesday.  I'm also
looking to see how mom is doing emotionally.  Dad returns to work and travel
in 10 days and there is no family or friends stepping in with help.  So sad.

I cannot express how much your words have helped me in this difficult case.

Valerie Vanderlip, IBCLC
Georgia, USA

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