Thanks, Barbara, for your post of ll/18/99 and for the validation of my
insights, the addition of yours, and the reference. I can't wait to go
get it and read it with a fine tooth comb. I have saved your post to
study further and keep on file.
As to the reference itself, already I have questions with the
terminology: (picky, picky:):)
< found that the nipple extend to
2-3 times resting length>
Plastic surgery, breast cancer surgery, and medical imaging literature
the world over have for years been using the term "nipple-areolar
complex".
Because this term is much more precise in describing what we are speaking
of when we are "mentally dissecting" and assessing a good latch, I
encourage everyone in the lactation field to add it to their vocabulary
when precision is important. IMHO, WE, of all professions, should be
using this word in our literature, our certification examinations, and in
our scholarly discussions and consult reports!
Of the literally more than 10,000 pairs of (or 20,000 individual) nipples
I have palpated and/or gazed closely at, sometimes with a magnifying
glass, in 40+ years of working with nursing mothers, I could count on the
fingers of one hand the NIPPLES that I believe, alone, might be able to
extend 2-3 times their resting length.
I think to state it this imprecise way is to muddy the waters of our own
understanding, and worse yet, the understanding of all those other HCP's
who have such little insight as to take it literally. It also tempts us
to muddy the waters of our clients' understanding.
If ANYTHING were to make a mother feel inadequate, I would think it would
be to tell her that we expect her NIPPLE (that small and very sensitive
and personal projection which is all she has ever seen protruding from
her breast, the mammilla proper, or nipple button, as I and my friends
call it) to extend (read: ST-R-E-T-C-H) 2-3 times its length while in the
baby's mouth.
What I believe extends to 2-3 time the resting length of the nipple
(button, per se) is the nipple-areolar complex. This is a 3 dimensional
concept I can illustrate very clearly by asking you to imagine using an
ice cream scoop, starting at the edge of the areola (or perhaps somewhere
inside of it in the case of someone with a huge areola). As you scoop it
spherically downward and circle back up to exit at the opposite side, you
have in your imaginary scoop the nipple-areolar complex.
It contains not only the nipple and the skin and muscles of the areola,
but the milk sinuses and the milk therein, the connective tissue and
perhaps fatty tissue between them and beneath the nipple, plus the
galactophores (the ducts leading from the sinuses outward to and through
the nipple), the blood and lymph vessels, and of course, in many early
postpartum mothers who receive labor interventions, any excess
interstitial fluid bloating and distorting all that tissue and resisting
the latch forces.
I like the explanation Felicity Savage King gives in her excellent,
clearly illustrated handbook "Helping Mothers to Breastfeed" , p.12-13.
"Stretching the breast tissue to form a teat-
A baby does not take just the nipple into his mouth. He takes a mouthful
of the areola and the breast tissue beneath which contains the
lactiferous sinuses. The baby must pull out or stretch the breast tissue
into a "teat" that is much longer than the "resting" nipple
(Illustration 6b.) THE NIPPLE FORMS ONLY ONE-THIRD OF THIS TEAT.
(Emphasis [not shouting] mine.) You can sometimes see the long, stretched
breast tissue for a moment when the baby stops sucking."
While in the US, "teat" is almost exclusively used in relation to dairy
animals and in the UK and elsewhere, to refer to a rubber nipple for a
feeding bottle, still, semantically speaking, I prefer the accuracy she
conveys in her explanation rather than the quote from the article above,
and if I am remembering correctly, also stated that same way at least in
the 1st edition of R & A.
I also have a problem with the term "tethered", but I will save that for
another day when I have read more and thought about it in more detail.
Barbara, I can't tell you how much I appreciate your style!
Now will someone please compose a limerick or a haiku or something with
this punch line?
". . .the nipple is only the tip of the teat!"
Jean
******************************************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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