I love the pontoon bridge analogy that Jean Cotterman proposes!  It would be
great to alert the mom pre-natally about retracting nipples, if this could
be done without alarming her and making her less inclined to even try, since
she is not "built right" for the job.  The counseling skills necessary to
provide this sort of info without sabotaging
maternal confidence are considerable, and it still seems to me that many of
the health professionals are not well versed in counseling technique.  This
is one area where LLLLs and Nursing Mothers Counselors are really often more
skilled.  I think prob. the place where we could most impact the issue of
retracting nipples is by the postpartum caregivers.  The hospt. LCs and
nurses are there when the baby arrives. Sometimes you get lucky and get
a baby who is so robust they can make the nipples work even when they are
way sub-optimal in terms of elasticity.  So the whole business is always
fraught with variability.  Which is why I always come back to the fact that
each dyad deserves intelligent case-by-case observation, and why we have to
know when to break our own "rules" (vis a vis using shields, immed.
prescribing postfeed pumping on Day 3 rather than taking a laid-back lets
see attitude, etc).

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html


Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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