A very nice first-time mother, in her 20th week of pregnancy, contacted
me about her inverted nipples (which I have not actually seen yet).
Despite breast changes and growth during the pregnancy, the nipples
still crater inward.  Given the unusual luxury of some time for this
question, (no crying baby in the picture yet!) I'd love to hear what
you-all now recommend in terms of prenatal preparation.  Shells and
stretching exercises seem discredited by some research (though others
have argued that the studies used British products with larger holes
that didn't focus pressure at the nipple base).  It does seem that a lot
of LCs still advocate shells, at least in the "it couldn't hurt."
category.

I 've first tried to promote her confidence -- she's on common ground
with every mother, wondering how things are going to go.  Every mother
needs to know about achieving a deep latch, and rolling a big chunk of
breast tissue into the mouth -- and that "babies don't nipple-feed, they
breast-feed."  And what competent little mammals many babies are, ready
to work with the breast they find..   And how we're lucky to have tools
available for getting milk out of her and into the baby, protecting the
supply while we work through difficulties.  And that a shield can be
useful as "training wheels" if the baby needs some help at first.

But, cheerleading and breastfeeding education  aside, how aggressive do
you get prenatally with drawing the nipples out?  There may still be
some breast changes ahead in the pregnancy.   In the archives, Jean
Cottermann discusses a regimen of pumping in the final weeks.  Earlier
than that,  I assume, we'd be worried about bringing on pre-term labor.
But if a mother has not been warned off sex, which also releases
oxytocin, is that really a worry?  My understanding is that the uterus's
oxytocin receptors are blunted until close to term.

What are your experiences with the Evert-It syringe?  I had one mother
using it (started on her own initiative before I even saw her) and while
the newly revealed skin was really fragile, it did seem to help draw the
nipple out..  Would that be something to start using before the birth?.

The archives also mentioned that there are different varieties of
inverted nipples -- could someone discuss that in more depth.  How would
I know what I'm really seeing when I meet with this woman prenatally.

Margaret Wills, LLLL, IBCLC, Maryland

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