For those interested: The MAIN  trial Collaborative Group. Midwifery, vol
10, 4, Dev 1994 pp 200-214.

It enrolled 463 women with at least one inverted or non-protractile nipple
and singleton pregnancy.  Gave them Hoffmans, shells, or nothing.  It
concluded:  no basis for recommending the use of either Hoffmans exercises
or breast shells...given the lack of evidence to support these and other
a/n preparations, there are no grounds for midwives to continue routine br.
examination in pregnancy for this purpose.

I'd also point to BMJ 304, no 6833, 18 April 92, where Alexander et al
showed (with a smaller sample of 96 women) that shells may reduce the
chances of successful bf, and no evidence of any effect of Hoffman's.

I will also post this to Lactnet, in case anyone else is interested.

UK practice is to do nothing with inverted nipples, though some midwives
suggest the Niplette thingy. It's years since I heard of a woman using
shells except to catch drip milk.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK

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