Helen makes a good point about watching our language when talking about "
graspable nipples."  Obviously the main reason that people get sore nipples
is that the baby's jaws are closing on nipple rather than areolar tissue.
However, in the case of the woman with non-elastic breast tissue, who also
has flat or inverting nipples, one has to hope she has a term, robust baby
who can generate enough energy to work with that kind of nipple.  The
problem for some babies (who are generally pre-term, small, weak, or
drug-affected) is that these babies don't get enough oral sensation
stimulated by that kind of breast.  The function of the nipple seems to
include a proprioreceptive "turn on" inside the infant's mouth which says:
Now suck!  If a weak baby doesn't get immediate stimulation and a quick milk
flow, they tend to give up.

This is why it is easy for some infants to imprint on a finger, a bottle
teat, a nipple shield.  Babies who are having difficulty feeding normally
due to size, stamina, ill health, neurologic immaturity, drug affect, etc.
may be much less able to work with a mother whose non-elastic,
non-protractile nipples fail to provide that "jolt" of stimulation.   Mavis
Gunther observed in the 50's, that babies often become "apathetic" when put
to such breasts.  They fall asleep to shut down from the frustration of not
really being able to figure out how to manipulate the feeding. The longer
the baby goes without nourishment, the less able the baby is to respond with
normal feeding ability.    When provided with other types of stimulation
which also deliver nutrition, of course they respond preferentially.  This
is not confusion, but an organism making a very smart survival decision.

The important thing to remember, in my opinion, is that humans can re-learn
and re-pattern behavior and do it all the time.  As babies gain strength,
stamina and maturity, and as nipples become more erectile with stimulation
(either through a shield or from pumping) babies can be transitioned back to
breast providing the milk supply has been well-protected.  The other
important key is that no matter how the baby is alternatively fed, baby
should spend skin-to-skin time at or near the breast at most feeds.  Even if
baby doesn't do anything at first.

  So many mothers have gotten the message that it's all over if baby has
gotten "confused."  In my experience, this couldn't be further from the
truth.  I just reassure mothers that we can take baby steps in the right
direction and wind up at the goal of exclusive breastfeeding.

Barbara



Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html