Teresa said:

<I have had some success with retracting nipples by more or less ignoring
them. I work on helping the mother get a really good latch - like Diane
W.'s
description of the baby "climbing the Matterhorn.">

I have finally come closer to this way of thinking as a more likely way
to help the individual postpartum mother.

Carole said:

<In my understanding, there is a difference between
"inverted" nipples and "retracting" nipples.  I am not
trying to begin a debate on semantics, just trying to
understand terminology.>

<I have seen this
retracting in the absence of maternal edema and am
hoping to uncover some strategies for both prenatal
and post-birth management.>

I agree that terminology is a large problem. As far as "true inverted
nipples", I have seen and photographed prenatally so many differing
"types" of inverted nipples, and done a lot of thinking, and even an
article on preparation of inverted and retracting nipples. I don't
consider the jury in on prenatal preparation for a mother who wants to
use it.

I have done photography precisely because a picture is worth a thousand
words. Even that is not able to put the idea across clearly enough, I
find.

As I said in a previous post, excess tissue fluid can be present and not
be visible until there is 30% more than normal, at which time, it is
labeled "edema". This "29% or less" is very common in the nipple-areolar
complex of many mothers, already in the 3rd trimester, IME.

Tissue fluid occupies space to contain it, and as I see it, the general
elasticity of the tissue is used to "contain" the fluid, and therefore,
is less available to allow adequate drawing into the baby's mouth.

In my minds eye, I see the asymmetric latch as applying pressure at a
different angle on the milk sinuses than equal compression on the top and
bottom of the "belly of the sinuses".

This results in less pain in the full sinuses, a greater "reach" of the
tongue to the proximal end of some of the sinuses, and a different set of
shear forces to effect any retracting of the nipple.

A HCP that sees a mother at single points during her maternity experience
 (i.e., someone sees her at her initial p.e. at 2 months, another person
may see her in the 3rd trimester, and another on the second day
postpartum in the midst of developing engorgement). They will many times
see a different picture.

Just yesterday, in our office we saw a mother who thought her nipples
must be too small, as the nurses had given her a shield, which was
accidentally discarded when she was discharged on the 3rd day.

She had consulted the hospital LC and reports she reassured her that her
nipples were NOT too small, they were "just inverted".

The baby was having latch problems and she called us to see if she could
get another shield. When she arrived (now on the 5th day), my co-worker
found her with very "ok"  looking nipples, and then discovered a very
obvious tongue tie in the baby!

Latchability needs detective work lots of times!

Jea
************
K. Jean Cotterman RNC, Ibclc
Dayton, Ohio USA

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