Sometimes it helps a mother just to know that she's not the only one who 
has battled through a particular situation -- the previous edition of 
the "Breatfeeding Atlas" (I'm getting the new one for Christmas!) and 
"Bestfeeding" by Renfrew had pictures of large nipples that you could 
show her.  Invoking the three rules: "Feed the Baby," "Protect and 
Increase the Supply" and  "Keep Something Happy Happening at the 
Breast"  can reassure her that there's a plan in place that brings those 
three strands together down the road.  If the baby really can't latch 
on, it might be worth experimenting with the standard-size 24mm nipple 
shield as a transitional tool (is there anything larger?) -- even if the 
nipple is squashed up a bit, it would at least keep the baby oriented to 
the breast and the in-arms, up against mom, skin-to-skin experience.  If 
the measured milk transfer is reasonable (and some breast compression 
might help) a shield might also cut down on the pumping needed to 
protect the supply.  Another positive point to make is that, as the baby 
grows, her large nipple will "compete" well with the firm sucking 
stimulus of the shield/bottle nipples she had to use to keep the baby 
growing toward breastfeeding.  Treat her like a heroine.

Margaret Wills, LLLL, IBCLC

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