Carole said:

I am amazed at the
number of nipples which, on examination, look
well-everted, but then retract toward the chest wall
with compression (the "pinch test")

I wonder if the problem is not that nipples are inverted but that tissue is
edematous?

Had another case just this week - Friday had a mom referred by an MD
because of baby with weight loss, high bili, and not latching on well.  We
arranged a WIC pump (double electric) and a nurse evaluated her and found
"inverted nipples" and incorrect latch by the baby, which she was unable to
fix.  Mom was sent home with various options, and she chose to bottle feed
her breast milk.   

Monday, a second nurse again was unable to get baby to latch.  Mom was
providing 100% of breast milk baby needed, and weight had gone up, jaundice
gone down.  

Tuesday I visited and baby latched on perfectly to the breast - but not
that I helped in any way...I just asked mom to put the baby to the breast
the way she had been trying without success...and baby latched on perfectly
and took in 1.6 oz. 

The nurse noted that mom's ankles and hands were now much less swollen than
the day before, but still are swollen.  Mom had and epidural...

Now the question is - was the difficulty caused by the epidural and the
lack of coordination by the baby after birth (latch on was at day 6
postpartum)?  Was the edema causing the difficulty and now that the edema
was resolving the baby was able to latch on?  

Too many variables!  Still, I wonder if the greater number of "inverted
nipples" is related to the greater number of epidurals and high fluid
loads?

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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