Nicki

<  Would prenatal assessment tell us very much? The breast, areola, and
nipple can change so much in the last weeks of pregnancy, during labor,
and
in the immediate postpartum>

I have done nipple function assessments in the last trimester on many
hundreds of women in the past 25 years, sometimes serially as pregnancy
advances. I have never seen functional retraction  spontaneously improve
during this time period. It only stays the same or gets worse.

<focus on
giving every mother on-going assessment and support in the hospital and
in
the first weeks at home.>

Surely. Mothers need all of that that we can give. Some are not lucky
enough to get it.  That doesn't mean something can't be accomplished at
the prenatal end, though.

< Peeking over her shoulder to catch a glimpse of that
nipple the instant it leaves the baby's mouth tells more than any
inspection
of nipples at rest.>

I need to define my terms. Functional retraction is not assessed by
eyeball inspection of nipples at rest. It is assessed by compression on
the areola (the Waller method), or by the mother or examiner holding on
to the nipple while the areola is compressed (the Otte method). I prefer
the latter because it so dramatically demonstrates to the mother what
"drag" the baby may be creating for itself by compression of the areola.

Additional palpation of the areola where the baby's jaws need to compress
can reveal the extent of subareolar tissue resistance, as well. Granted,
this changes sometimes feeding to feeding, but IME, it always gets worse
(more resistant) before it gets better by 7-10 days post partum.

I will make this one my last post to Lactnet on this subject as I have
whipped this horse good and tired, and I do not want to wear out my
welcome there.

Jean
********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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