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Subject:
From:
Cindi Swisher <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 15 Dec 2003 14:12:24 -0700
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Hi Mary,

Does the mother state that she has pain while nursing?  Are her nipples
pinched or cracked?  If not, then while I agree that supplementing at the
breast is the best way to supplement, I'm not sure I'd personally go so far
as a shield.  If little one is sucking at the tip of the nipple anyway, a
nipple shield may make that worse.  I.e., if she won't keep him latched well
without a shield, I seriously doubt she'd keep him latched well *with* one.

If the mother won't / can't get a better latch or won't keep working on it,
I'd tell her what I've told several moms in my practice...
"Ok, we've seen that with a good latch and plenty of compression and focus
on the baby while breastfeeding, the baby can get a good amount of milk.
It's possible.  You have the power.  We've gone over how to increase your
supply.  You know what needs to be done.  What would you like to do?  How do
you want to handle it now?  How can I help you?"

Maybe before that I'd bring up the idea of an SNS to "make supplementing
easier".  If she doesn't want to go the SNS route, then I'd have to
seriously think about cutting her loose.  I've had to do it before to keep
my sanity and it's not easy, but there comes a time when it *is* very
necessary.  I don't think there's much more that you can do at this point.

One mother I worked with (preemie and low milk supply), did very little of
what I suggested, but she called me very often and said, "what do you think
about this...?" and I'd tell her my thoughts and she'd do what she wanted.

I actually had to come right out and say, "I've shown you everything I can,
I really want to help, but there's not much more I can do at this point.
I'm going to leave it to you to let me know how I can help.  Call me if you
want to talk."  And that was it.  She called, like I said, and often, but I
never called her.

But you know, that mother has referred other people to me and has gone out
of her way to tell me how much I'd helped her.  I can't see how, unless it
was just to listen to her.  But early on with her I put my personal
"firewalls" up and then it didn't bother me or frustrate me when she asked
me what to do and then went ahead and did the opposite.  It made it easier
for me to listen to her without screaming, "why are you calling me????
you're going to do what you're going to do, so why ask me???"

Anyway, best wishes for you Mary, I feel for you.

Regards,
Cindi Swisher, RN, IBCLC
Private practice in Colorado Springs, CO, USA

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