Denny wrote me to ask if I don't think the bottles/supplementation create the problem. No. The feeding problem pre-dates the exposure to the bottle (ie the babies are preemies, in the case of her twins). By the medical definition coined by Lawrence, Neifert and Seacat in their article on the subject in J Peds, 1995...."The term should not be applied to situations in which a newborn infant displays a primary inability to suckle the breast effectively, without prior exposure to an artificial teat such as a bottle nipple, pacifier, or adult finger." I work with babies every day who have been bottle fed for weeks. It is very easy to get these babies to breast. You first hypnotize the moms to stop believing in nipple confusion. What good does it do for them to believe in it? That is what makes them wean. They believe its all over now because they gave bottles, plus they're dying of guilt because their choice was starve baby or supplement. It's unbearable. Of course you don't give teats cavilierly in the early pp. That's a sensible rule for the normal baby, but none of the babies we're talking about (the ones whom the discharge nurse or LC should have red flagged) are normal. Think about the issues Kay James talked about. These kids are high tone or low tone or immature or ill or injured. Or mom is a poor physical fit, or is ill or surgically affected or hysterical. Everyone blames the bottles instead of the dysfunctional baby or the poor milk exchange. If the mom has breast which are full of milk, had nipples baby can grasp, and if both have finally recovered from the delivery or the prematurity or the illness/injury, all you do is get mom naked in side-lying and feed baby a couple of good swigs of milk so it isn't hungry, and let them crawl to the nipple. Sometimes I sandwich it up and tickle their lip a min. or use a shield, or drip some milk into their mouths for a min or two to encourage them, but then they latch and take a few sucks. That's the start. Remind mom that nursing is PT for the oral structures, which are weak from not nursing and have to tone back up. If baby still can't nurse at 2 weeks down road, baby still has a prob. or nipples are still not graspable (tight, too large, functional retraction, low milk reward). Keep feeding baby, keep protecting milk supply, keep doing nuzzling and licking and practicing at most feeds when baby isn't hungry. Sooner or later they'll usually nurse. Never give up, and prepare mom that some babies won't nurse till due dates or when they recover from cephlahematomas or forceps bruises or clear all meds. Not a prob. I tell them. Just keep doing 1,2, and 3 and baby will go. We prime moms to fail when we blame the supplemental methods instead of the baby's inability to feed normally. I disagree that most of these babies were feeding well before supplementation. They were TRYING VALIANTLY to feed, but because nothing was happening they gave up. If not supplemented they would starve. They are not CONFUSED by bottles, etc. just grateful and making the smart survival choice. Make breastfeeding work as easily and why wouldn't they nurse? They are hardwired by a zillion years of mammalian evolution to prefer it. That is my belief system and I find that having this as my dogma results in a high level of success transfering everyone back to bfg. which is always my goal and is typically the way these cases resolve. Barbara Wilson-Clay, BSEd, IBCLC Austin Lactation Associates, Austin, Texas http://www.jump.net/~bwc/lactnews.html *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html