Arly, you stated that you have never had a mother stimulate her own nipple
prior to a feeding.  That you do not feel having the nipple more erect  would
help the breastfeeding and just brushing the nipple near the baby's lip  would
stim the nipple.
There was a film from Europe, I cannot remember where, that showed moms
gently rolling and tugging their nipples prior to feedings.  What this does  is
start the hormonal stimulation and there are many women who bring up  colostrum
just doing this.  I have been doing this with every mother,  especially in the
first 2 days so that they get comfortable with touching, bring  out the
colostrum, and I can see how responsive their nipples are.  I do  not like to be
the ones to touch their nipples because it may not be comfortable  for them and
I could potentially pinch too hard.  Also having the nipple  stimulated is not
for the baby to latch onto the nipple but it does give a  firmer stim to the
baby's face and mouth.
Regarding your next comment you said:
    >What I wonder is, in a nipple that in late  pregnancy has shown little
to =
no
protractility, and has not improved in  the hours since delivery and the =
baby
for whatever reason can't take the  whole nipple-areolar complex into his
mouth and breastfeed successfully, what  are others doing to correct the
situation?  I've seen these situations  correct themselves, and I believe
most of them can, but there seem to be only  two tools for change other =
than
the baby:  the pump and the reverse  syringe.  It would be a shame not to
correct a correctable  situation.  I wonder if some people just use the
nipple shield for  years-one of my clients graduated off her nipple =
shield
and said, "Oh,  I'm so glad I don't have to wear that prosthetic nipple
anymore."<

As I was studying for my rectification this year one of the text I read
stated that many women through pregnancy and immediately postpartum have flat
nipples.  As the nipple is pulled on by the suckling baby, they become more
protracted.  This is especially true of primips.  As you had stated  earlier the
baby needs to latch onto the breast tissue not the nipple so being  slightly
flat is not the issue.
I have found in the first couple of days the nipple more sensitive so
pulling on it with a pump or syringe can be uncomfortable.  If a mother has  to use
a devise to pull out her nipples the baby has to be slightly away from  her
breast.  By the time she brings her baby back to the breast the nipple  may be
flattening out again.  If a mother uses her own hand then the baby  can stay
right next to her breast and be there with a wide open mouth to latch  on.
I strongly believe women should wait until they are at least 24 hours
postpartum before introducing a nipple shield.  I find it more difficult  for the
baby to obtain the droplets of colostrum through the shield.  Also  if she has
any areola edema the nipple cannot reach deep enough into the shield,  even
with reverse pressure.  Having the mother hand express, dropping her  colostrum
onto the baby's lips and mouth has the benefit of knowing the baby  actually
got the colostrum.
I do use shields and feel they have many benefits and some dyads need them
long term but they are an extra thing to think about and when they can be
weaned  off, I encourage a mother to do so.
Ann Perry, RN IBCLC
Boston, MA




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