This is the first time I've ever heard of "nipple hernia" as well. As with all breast surgery effect on breastfeeding, the location and extent of incisions and whether or not they interrupted the neural pathway from nipple to the spinal column for signaling MER would be important to observe for. And regardless, it would be good for mom to have a thorough explanation of what the MER is all about so she too can help observe, and perhaps reassure herself.

Though 2 hours of IV pitocin is not a long stretch by comparison with many moms who have it for many hours before, and for 3rd stage management for 12-48 hours or so, she may also have had larger volumes of IV fluid without pitocin for purposes of anesthetic management. IME if this led to >2000 cc. total of oral and IV intake of fluid in any 24 hours, as a result, she is more likely to get breast edema within 48 hours, before L-2. Note, this is not research-based (yet), just my observation over the years of changing perinatal management. Swelling in her ankles would be a dead give-away that some degree of overhydration existed, though even if no pitting is visible, some edema might be there. (Edema can be present without actual pitting because pitting does not occur till tissues are holding up to 30-50% more fluid than the tissue normally holds-Guyton)

So, reverse pressure softening taught early (ASAP, before much swelling can take place from either edema or L-2) and encouraged before every attempt to latch for the first 2 weeks or till not needed, may serve 2 purposes. 


       1) It can make the areola (which may have some scar tissue) more "baby-friendly" and pliable as it can possibly be from the time of the earliest latching attempts through the period of potential breast swelling, to reduce potential for nipple pain and/or damage. 

        2) If the neural pathway from the nipple to the spinal column has not been totally severed, steady but gentle (no discomfort, ever) RPS held steadily for a slow count of 50 will trigger MER within 1-2 minutes later or less. 


Even if the neural pathway has been severed on one side and not on the other, MER will happen on both sides if the message can get through on even one side. If not, then stimulation of the upper breast by gentle alternate breast compression and/or massage can hopefully find a neural pathway to stimulate the MER. If that fails, the substitute "forward push" of the milk will need to be supplied all through the feedings by alternate breast compression a la Jack Newman.


I would be absolutely against any use of a pump on this mother, at least in the first two weeks. Vacuum never pulls. Other forces push. And scar tissue trying to help equalize the negative pressure of vacuum would only complicate repaired anatomical areas as well as permitting any possible excess interstitial fluid from the IV's to push it's way into the subareolar area "like a swamp after a rainstorm", with the crowding compressing the ducts from the outside, blocking exit of milk, MER or not. 

K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC       Dayton OH

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