Someone posted:
> I thought we had stopped using the Hoffman technique a long time ago.  If
> I am wrong please let me know.  I haven't used it for years.

Someone replied:
>My question- WHY have we?  Was there research done? I know that research
>isn't necessarily the answer but we also need to beware of trends or
>styles.<

I agree with both posts, but the basic question is, what was the basis for
ever believing Hoffmannn's was either safe or efficacious? Answer as best I
can tell: the printed word of a single 1950's obstetrician in
bottle-feeding USA.
Moral: read the original research.

In the absence of research, we don't dismiss everything, but we do need to
think about basic physiology. So the question becomes, why would digging
one's fingers into highly vascularised growing breast tissue behind the
nipple itself cause a nipple to be more protractile or erectile? (which is
what we want). Would  we solve problems of non-protractility or
non-erectility of sensitive male tissue in an analogous manner, by
compression of adjoining tissue attempting to force projection, or by
attempting to break down adhesions we have no reason to believe exist? (The
basic defect of inverted nipples is thought by surgeons to be short
lactiferous ducts (which can grow), not adhesions)

Thanks to whoever posted the MAIN trial results. But I contend that anyone
with half a grain of commonsense and some basic knowledge and training to
THINK can make an educated guess about the likely success of a proposed
treatment, ruling out the obviously harmful and clinically trying the
apparently safe, before any RCT is done. Indeed, this clinical knowledge is
often what stimulates a RCT to "prove" or disprove what we have all by then
accepted. It was no surprise to anyone I know that shells (which push
breast tissue in, not pull nipples out) and Hoofmann's didn't work. The
cobbler should have stuck to his last, and we breastfeeding advocates
should have used our brains and never popularised this or much of the other
nonsense that passed for truth, such as Applebaum's diagrams (pinched from
Charlotte Naish in the UK, another obstetrician) of how babies feed. If
what any expert says contradicts commonsense, it is highly likely to be
wrong.

So, for instance, I am making an educated guess that the Nipplette does
work, because it should work from first principles (tisse stretched grows);
and that properly used it can be efficacious although there are obvious
safety concerns. I'm happy to wait for a RCT on this. And I already have
reports from women who've used it successfully, and yes, some were too keen
and caused fissuring, but that was trivial to the fissuring they would have
experienced with baby feeding on inverted nipples...Its chief problem is
its absurd and unconscionable price, morally repugnant to anyone with any
social conscience; and the fact that the makers have not even bothered to
make small medium and large nipple sizes (no doubt the extra moulds cost
perhaps an extra few dollars and each extra plastic cup would be a few
cents off the obscene profit margin they must be creaming.) Perhaps it
would be interesting to compare prices and Lactnetters who want them
organise buying them from the cheapest country: I heard the UK price was
around A$20, Australia is A$55; and the US is $100US. Is that right?

But what other body product is sold in one size? Are all feet size 5's? all
hands size 7's? Why should all nipples be Niplette average? and who can
find an e-mail for the company so we can tell them what we think about
nipple size, and pricing policy?

Syringes will work because they are the right design for the job. They are
much less convenient and will take much longer to achieve the same result
as the Niplette because they are not applying continuous gentle stretching
and cannot be locked on. I'd go for the Niplette any day, since even one
day of cracked nipples costs a lot more than US$100.

Maureen




Maureen Minchin, IBCLC
5 St, George's Rd., Armadale Vic 3143 Australia
tel/fax after March 1: 61.3.95094929 or 95000648