I have been a hospital based LC for my 17 years. I feel like I am seeing more flat nipples over the past several years than I did when I first started. I agree with many of you about it being a tool, the need for proper education on its application and the baby's latch, need for follow up. Some of my coworkers are getting the message about allowing time and hand expression. I have found that the night shift has been the loudest about needing access to nipple shields.

    That said, how about my biggest beef: why are MD's not assessing for flat nipples prenatally and referring women to LC's early? What can do do prentally to help these mothers who have flat/inverted nipples before they even get to use? We have been trying Supple Cups but only 1 MD referred a patient and I did not think her nipples were flat. 

Allyson Michaels, RN, IBCLC
Charlottesville, VA

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