As I've said before on this list, and I'll say again now, it is the babies who have been given long straight bottle nipples in the early days who give me the greatest difficulty in attaching at breast.  When these became popular, my skills at getting babies to the breast, built up over the years, became less effective.  If the mother has large soft breasts and smallish nipples, babies often don't "get" how to draw out the breast to make a teat and they imprint on the hyperstimulation of the long, preformed, hollow artificial nipple - which they don't need to draw out.

If mothers are already using bottles with very young babies, I ask them to use 2-3 different artificial nipples so that they don't use the same one all the time, and then the one constant oral experience is the mother's breast.  We can then work on the supply or other issues.  I recommend the same if mothers come to me to increase a low supply when their babies are past the newborn stage.

Depending on my individual assessment of the breastfeeding dyad, I'd prefer, if the supply is okay or only slightly low, to make judicious use of a well-fitted nipple shield, so that the baby is feeding *at* the breast and not separated from Mum by a bottle and all that involves.  It also helps the mother's confidence to see milk transfer happen actually at breast.  Even so, I use shields only very seldom, even when it is one of the tools I might consider.  It is only when it is right for *that* mother and *that* baby in those particular cirumstances.

Bottles have been associated in the public mind with babies in Australia for generations and bottle and dummy (pacifier) use is deeply ingrained.  I still get the sense that families consider babies who will accept bottles and dummies as "good" babies, somehow seeing the use of bottles (even if containing EBM) as somehow "normalising" infant feeding.  Despite this, it is good to see more and more mothers with positive ideas about breastfeeding, but a lot of cultural change is still needed.  Advertisements such as the ones for "green" bottles or bottles that are "fun" to play with, delay or prevent that culture shift with yet another generation.

I'm still in respite care waiting for 2 fractured legs to heal before rehab is possible. But, hey, I have my laptop and email.

Virginia

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA
Honorary Research Fellow
School of HPRC
The University of Queensland

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