Patricia,
< I think the question of whether or not piercing will help the
"inverted"
nipple depends on the cause of the inversion. inverted nipples are
classified
as either umbilicated or invaginated.>
I am in total agreement with you on this point. I hope to hear more
people using this definitive terminology. I have seen "degrees" of
umbilicated inversion. I have only personally seen on mother with an
invaginated inversion.
However, understanding the difference is important in being able to
explain a mother's situation to her and make appropriate recommendations
as to how to intervene. Only then can she make a truly informed choice.
One problem lies in the fact that some nipples are so deeply umbilicated
that it cannot easily be determined which type they are without a good
trial of vacuum preparation. One clue is that the milk sinuses are
probably nearer to the surface with umbilicated nipples than with
invaginated.
< If mom can get the nipple out then it
is umbilicated and I would think that either the nipplette or the
evert-it
used consistantly would encourage this nipple to stay everted.>
I have cared for at least one mother whom I started at 37 weeks
gestational age on a double pump used for 15 minutes 4 times a day. This
was after wearing shells for 2 months previously made no change. I had a
strong hunch from observing her that they were umbilicated, but nothing,
including the Hoffman maneuver, brought them into view prior to the 2
weeks of q.i.d. pumping .
One week before term, her nipples began to consistently evert for 10
minutes or so when the pump was used. By term, she was able to evert them
manually most of the time. (I presume this was due to the principle of
tissue expansion, which I am now reading up on after seeing the term in
Dr. Scholten's letter to the editor.) This mother successfully nursed
without pain or damage till she chose to wean for other reasons at 6
weeks. She was very pleased with her experience.
<If the nipple
is invaginated mom probably can not get it out... in which case it again
would be less invasive to try either of the afore mentioned techniques.>
If a nipple is truly completely invaginated, the skin that would have
been over the surface of the nipple, lines the deep, tight pit, and there
is no mammilla, per se. I have seen a case where he milk sinuses seem to
be buried deep behind the pit. Massage, a well conditioned MER and a
pump (to collect the milk as it arrived in the pit) allowed relatively
good milk transfer.
I recommended to the mother in this situation that she could choose to
nurse one side and pump the other for feeding in some other way, or
choose to nurse onesided and gradually let the side with the invaginated
nipple involute. Due to her busy home situation, she chose the latter.
When I last had contact with her when her baby was 4 months old, she was
EBF on the non-inverted side.
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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