> At work I am naturally always given the moms with breastfeeding
> problems, mainly flat nipples and difficult latch.  How do you all
> go about helping these moms.  Maybe I'm asking for the impossible quick
> fix, but I am getting frustrated with my ability to help these women.
>

I posted earlier about attending a talk by Diane Wiessinger where she showed
a video (actually, several videos) and talked to us about helping babies
latch. I used the technique with a mother with flat nipples and a
non-latching baby and it worked wonderfully (still going well, by the way).

I will try to describe it as I understand it - but Diane can probably
describe it better. You might also include something else she talked about:
holding the baby skin-to-skin upright on the mother's chest, and waiting
until the baby, on his own, tries to move down to the breast. Then the baby
is positioned so that, with the breast unsupported, the nipple is pointed at
his nose. The mother uses a finger or two to press into the breast above her
nipple, pointing it upwards, and then rubs the baby's lips with the part of
her breast below the nipple. This stimulates the baby, with head tipped
back, to open his mouth wide, and as that happens the mother can "unfold"
the nipple (and some breast) into the baby's mouth. It is easier to see this
on the video, I think.

I myself have very flat nipples and yet all four of my children latched on
well and breastfed with no difficulty. I was thinking about this the other
day and realized that I nursed them all immediately after birth while lying
down on my side. In that position, I was not supporting my breast but doing
something similar to what I've described above - using my fingers (with that
dreaded cigarette hold with the first two!) to move the nipple and breast
against the baby's mouth and then kind of tipping the nipple in once the
baby gaped. And moving the baby's body close at the same time. Hmmm...

I think the most difficult situation with flat-nippled mothers is when the
baby has had a bottle or pacifier or even finger-feeding, because you can
just see the baby searching for that big firm nipple. He can have the breast
right in his mouth but won't suck or do anything because he's expecting a
rigid nipple. Sometimes in those situations I will suggest that the mother
try nipple shields for a period of time, to help the baby at least get the
idea that milk will come from the breast. The trouble is that the nipple
shields often don't fit these mothers very well - they seem to be designed
for mothers with bigger nipples, even the smallest sizes I've been able to
find. I have had some mothers have some success with them, though, and it
may be worth a try for some of the women you work with.

Teresa Pitman
Guelph, Ontario

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