Anne,
I have noted that most cases of "flat" nipples (diagnosed by postpartum hosp
staff) I see turn out to be engorgement.  If epidurals cause suckling
difficulties, the decreased effectiveness could easily lead to maternal
engorgement, which stretches the breast skin, taking up the "slack" that
allows the nipples to be protractile.  After pumping and breastfeeding, these
nipples become totally normal.  Have you personally examined these moms with
"flat" nipples?
Catherine Watson Genna, IBCLC  NYC  [log in to unmask]