Susan,
One clear thing I think this shows is how loosely the term "inverted
nipples" is used! Epidurals causing nipples to be inverted? Semantics is
at the root of this misunderstanding, I believe. "Retracting" is what
they must mean.
As for frankly inverted nipples, over the years, I have followed four
such moms with my camera, trying various interventions from prenatally on
into the postpartum period, with unpublished case studies. The inverted
nipples were of at least two different types and were present before
pregnancy began, and certainly, before delivery.
I have done a great deal of fascinating reading on the development of the
human nipple, and gained some insights on both inverted and retracting
nipples. It is possible for nipples to appear everted yet function with
retraction, even prenatally. Testing with the Waller or the Otte method,
can demonstrate this even before delivery.
Adding to what plentiful, or sometimes excess interstitial fluid that may
be present in the breasts prenatally, the "superhydration" that is
deliberately brought about with IV's for epidurals is likely to cause
some swelling in all tissues of the body, .
When the breast tissues must supply their elastic capability to stretch
to contain that excess interstitial fluid, there is little or none to
spare to evert the nipple on compression of the areola. (For a simple
demonstration of this, simply blow up an oblong [not a round] balloon and
watch the eversion of the "nipple" end disappear as a greater volume of
air inflates the balloon.)
This situation will of course be exacerbated when blood vessels dilate,
extra circulation occupies even more space, and then formed milk begins
to dilate the alveoli, and the ducts, and the milk sinuses. I think this
is the basis of what might be the appearance of flatness or even
retraction of the uncompressed areola, or at least a cause of functional
retraction on compression of the milk sinuses.
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio
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