Arly, I remember when the reverse syringe came out and I would find one at
almost every bed side.  :-(   I did not ever see any great  advantage to this
devise.
Since that time I have slowly learned what to have mothers do if their
nipples and areola are a challenge for their babies.
I have all mothers stimulate their nipples prior to feedings.  This is  to
help them learn about their anatomy, get comfortable touching their breast,
stimulate their hormones, and start bringing the colostrum down.  I access  the
nipple, areola and breast at this time for potential problems.  In the  first
24 hours postpartum I have the mothers hand expressing their colostrum  onto
the baby's lips and mouth if they do not latch.  If there is areola  edema I
have the mothers use Reverse Pressure.  In the next 24 hours if the  baby is
having difficulty latching due to mother's anatomy, I may introduce a  hand pump
if the hand stimulation is not effective enough and at this time may  use a
shield.
The wonderful part of all of this is; I am still learning.  There will  be
ideas that at first glance appear great but after time and experience do not
pan out.   AHH, the wonder of learning.  :-)

Ann Perry, RN IBCLC
Boston, MA

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