Jean Cotterman has given a wonderful description of inverted nipples and
her understanding goes way beyond mine.  But I would like to second the
suggestion that the Niplette may be helpful, depending on what you see
when you examine the mom.  (It is now marketed by Avent-- www.Avent.com
and search for Niplette.)  They are designed to be used prior to or in
early pregnancy, but I don't usually encounter these women until they're
at breastfeeding class in late pregnancy.  Often a woman will tell me
she has inverted nipples, but when I check, she really doesn't.  If the
nipples look flat or even "tuck" into the breast but the areola is
flexible and I can draw up a nice chunk of breast tissue, it's usually
not a problem.  I do tell her what is likely to happen if she has a lot
of IV fluids during her labor, and teach her Reverse Pressure Softening
(thanks Jean!) because if she ends up with areolar edema, her baby is
likely to have a lot of trouble initially.  If her nipples are inverted
so that I cannot get my fingers behind them and get them to pop out, I
figure the baby is not going to be able to, either, and suggest the
Niplette.  I have had very good success with it, it can be worn
unobtrusively if the mom has one of those bras with a thin foam shell,
and provides a permanent correction.  The one drawback I see is that it
comes in only one size which is fairly small, so if a mom has deeply
buried wide nipples, it is unlikely to work.  And if the mom is leaking
a lot of colostrum, the vacuum will be hard to maintain.  Since I'm
seeing these moms at the end of pregnancy, I just get an okay from their
OB doctor for the mother to use it.  I think the possibility of causing
contractions is completely unlikely and all the docs so far have said
"fine" but the Avent literature advises against use in late pregnancy.
It's really a great little invention.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin
(don't work for Avent, find them a PIA to deal with and don't like most
of their products, but like THIS product)

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