>
> Paula, I hear you!  And I know you have our collective support.  We all have
> bad days when everything we try for one mom/baby pair seems not to work.
>
> One question, could you describe (in detail, please!) what "flipping the
> nipples" is?

From a previous thread on Lactnet re: inverted nipples...a session at
the Northern Calif/Hawaii area conference was mentioned. Molly Pessl was
the presenter  and a fellow lactnetter shared her thought here re:
bringing forward inverted nipples (flipping was a nickname for it given
during private e mails). I understood the technique to be as follows:

place fingers at base of nipple, pull fingers away from the nipple base
and press in slightly to *flip* the nipple forward.

If this is inaccurate any correction will be appreciated.

As i was assisting this mother with inverted nipples, the position that
worked best involved mother sitting cross legged (tailor sitting) with
infant resting on her leg sitting facing mother but slightly turned to
side. This mothers breasts are long, large and both nipples invert when
compressed. Mom was not hunched - due to the length of breasts and
length of baby. Her back and arms were supported.

I was dirctly in front of her. Placing the thumb and first finger of
each of my hands along either side of her nipple (left breast) base,  I
then slid fingers away from nipple and then gently pushed inward hoping
to *flip* the nipple forward and out.

I thank the fellow lactnetter that shared this info from Ms. Pessl's
session. It did come forward, and the nipple was not stuck (adhesed) to
adjoining breast or nipple tissue.

With the nipple in an everted position, I held the breast tissue in a
*pinched* position approximately 3/8 inch away from the base (to the
left of the nipple) on the areolar tissue, as we brought the (then calm)
baby up to the breast. We brushed the baby's mouth with the nipple (i
was - at that moment - unconcerned if we contacted the upper or lower
lip of the baby). A few times this brought success in as far as opening
the baby's mouth and she (8# 15oz) would latch. It was more of a
sucking-onto-the-breast than i *like*...but it was a real step up from
not latching.

This was all in the hospital. The nurses worked with her and had very
similar success, but it was admittedly very difficult. I showed a family
member the *process* and how to introduce EBM (or ABM) at the breast
with a p syringe, to reinforce and/or encourage the infant to continue
to remian attached. Even so, the baby would pull off (or lose the breast
as nipple inverted?) often.

I left the mom (on the home visit) with the thought that there are more
things to try (interventions). I did not mention a nipple sheild, but i
had it in mind. So nice to hear concurring thoughts about its use here.
I very rarely use them. Mom said during home visit that she was at the
point of not caring if infant *nursed*, just wanted to be using human
milk.

Any thing i'm missing or confused about warrents clarification. Don't
hesitate to mention or correct. And i thank each and every one of you
for your warm responses and support.

Paula Bermingham, IBCLC
CEMR-WIC