The induction rate in our facility is about 75% and the epidural rate about
the same. (Lots of intrapartum fluids.) I too see many women with seemingly
dense, very firm breasts, and inelastic nipple/areola complexes within the
first  24 hours of birth. Of course their babies are having latching difficulties,
and  the nipples very often retract inward with areola compression, making it
 even harder for the babies to maintain a latch. That is if they (the
babies) are even interested in attempting to nurse.


Since I have only been in my position 2.5 years, I don't know if this
"epidemic" of non-latching babies, and hard to hold onto nipples has always  been
the case, but the nurses tell me it's been getting worse as the birth
interventions increase. We support breastfeeding by encouraging Skin-to-skin  contact,
and beginning hand expression and/or pumping if the mother will do  that, so
that lactogenesis II will hopefully begin on time. It is rare and  refreshing
to see a little one nurse well and frequently, and lose very little  weight in
the first 48 hours. Most often I notice this happens when the mother  is an
experienced "breastfeeder" and there may have been no time for IV  narcotics
and/or epidural anesthesia. Or she is having a scheduled repeat  cesarean and
only gets a spinal and the baby nurses within the first 2  hours.

I do not think most OBs assess nipple function during the  prenatal physical
exam, but I am on a mission to get the CNM to do it as part of  the breast
exam all women get during the first OB visit. Perhaps she will be  able to get
some data on baseline breast and nipple tissue elasticity, and  then reassess
those with inelastic tissues near the end of pregnancy to see if  the hormones
of pregnancy have made the tissues more elastic.

Is anyone interested in doing research to see if there is a connection
between oral contraceptive use and those dense, inelastic nipple/areola  tissues we
are observing?  I think it would be a fascinating topic to  study.

Mary-Jane Sackett, RN, IBCLC, RLC, CCE
Pittsfield, MA
The Berkshire Hills region of New England

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