I was called in today to help in the nursery because the babies were all "on
strike" having evidently made a pact that none of them would breastfeed.
 Most eventually nursed.  However, one mom-baby dyad represented a real
challenge, and I did not find a satisfactory solution.  Mom's areola was very
firm and non-compressible.  Baby was 24-hr. old, term, and had never
breastfeed.  He had been bottlefed at least 3 times.  However, the nurses
reported that he bottlefed poorly.  The baby never opened her mouth wide
enough to latch on.  She cried whenever we tried to latch her onto the
breast.  The only alternative feeding method approved in our unit is the SNS,
which did not seem appropriate in this case.  So, we tried calming her down
by giving her a few sips from the bottle.  She did not suck well.  She still
would not or could not latch on.  She was eventually bottlefed by her parents
and took 18 cc.  She was taught to pump her breasts using a double set-up and
Lactina pump.  She had a good supply of colostrum.  She was discharged with
instructions to offer the breast at each feeding and then supplement with
formula or pumped breast milk and to pump her breasts at least 6 times daily,
ideally every two hours.  She is to call the pediatrician tomorrow and see
her on Friday.
One of the nurses who took care of the baby last night stated she felt the
mother had fibrocystic breasts because she had lumps all over her breasts.
 (I did not do a complete breast assessment).  The mother denies history of
breast surgery and I saw no evidence of such.
Does anyone have suggestions?  Has anyone had experience with this problem?
 I encouraged a consultation with a community-based lactation consultant.
 The mother was exhausted and both parents (father especially) wer anxious to
go home.  I felt that I had probably already given all the information
(probably more) they were able to absorb.