The midtongue elevation you are describing is usually another symptom of tongue-tie. Sometimes the tongue attachment is too close to the gum ridge rather than being too short, this causes the tongue tip to appear free, but the tongue to be restricted further back. Which either pushes the nipple out of the mouth when the baby tries to extend the tongue and the midtongue rises, preventing latch; or prevents the tongue from extending and pulling the nipple back deeply into the mouth, leaving the nipple compressed as you are seeing here. If it is not severe enough to warrant a frenotomy or frenuloplasty, the following may help: Extend baby's head when approaching the breast (tip it back) so the lower lip comes to breast first. Start out with the lower lip on the areola about a half inch away from the nipple. When baby opens his mouth (he will open wide, because the nipple is far away) have mom pull him in quickly. This usually makes for a decent latch. Have mom lean back so baby is nursing "uphill", as these babies often gulp and choke. As for the breastpumps, tell the mother that the type you can hold in one hand have tiny motors that need to work for a long time to get one suck:release cycle. The better pumps have large motors, that allow the pump to cycle 40 or more times a minute. More like baby, less stress on the nipple because it is only pulled for a fraction of a second, instead of several minutes at a time. I recommend Ameda Egnell or Medela pumps, either the rental models or the personal double pumps (Purely Yours or Pump in Style) depending on how long the mother is going to be seperated from the baby. The greater the seperation, the greater the need for the hospital grade pump. -- Catherine Watson Genna, IBCLC New YoX-Mozilla-Status: [log in to unmask] *********************************************** 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