Hi All,
I have an interesting case I would like to share.
This woman requested a prenatal visit with me because she had inverted nipples
and wanted to breastfeed. THis was her first pregnancy. On exam: breast small
to medium size with med size areola and bilaterally inverted nipples that
would not evert with stim. The woman was very self conscious about them and
was afraid she would be considered a freak by the hospital staff.
THis is the care plan we developed:
- No shells prenatally but could do nipple rolls and would give info on nipple
rings only for  the purpose to expose inside nipple tissue to air.
Postpartum
- Plan A: Brfd in del rm. Use rooming-in and brfd on demand, make sure baby is
rooting and grasping at least 2 cm of breast tissue. Patient does not need
inverted syringe or br shells pp. Patient would like to maintain as much
privacy as possible.
- Plan B: If there are complications at birth or during stay that interfere
with the baby's ability to brfd, patient is to obtain ele br pump at hospt and
pump every 2-3 hrs during day and every 4 hrs at noc, giving what ever she
obtains to baby. Efforts will continue to encourage baby to brfd. If formula
is needed, to use hypoallergenic type - to avoid cow or soy-based formula due
to family histroy of allergies and medical problems. If baby needs
supplementing, to use cup, no artificial nipples ro pacifiers.
- Plan C: If during course in hopst stay, baby is unable to latch-on and brfd,
patient will use ele br pump. Keep baby skin-to-skin. Patient to learn cup
fdg.

This letter went to the woman, her clinicians, the hospital and the LC who
rounds at the hospt.

She went to term, ended up with a C/Sec and became septic, needing antibotics
and baby in NICU for a couple days. So she went to Plan B. Dad did the cup fdg
in nursery. She got the baby to latch to one side while in hospt and by end of
week had baby nrsg from both sides. She did experience sore nipples and used
lanolin. The niples are now pulling out with feedings but still tend to turn
back in.
I think positive thinking, a very motivated mom and a care plan did the trick.
I love happy endings!
Ann Perry RN IBCLC