I find that most these can be eliminated by improving the positioning as
described in Barbara Wilson-Clay's and Kay Hoover's book THE BREASTFEEDING
ATLAS (see page 10). This is the best written instruction of a good latch and
the importance of proper jaw orientation that I have ever read and I have all
the books.  Many times this type of positioning and attachment is called the
Chloe Fisher or Jack Newman latch and it works well on most pinched nipples
and most nipples for that matter.  Less trama to nipple and more transfere of
milk.

Another source of help, is in this months LEAVEN (a LLLI Leader's journal).
The article by Karen Zeretzke called "Helping the Mother with a Baby who is
Reluctant to Nurse."  On page 100, for the baby whose tongue is retracted
(not extended over the gum line, and not due to tongue-tie) which could also
cause a ridge running across the nipple.  Karen describes the CHARM HOLD as
follows:  "Lay the baby across his parent's lap face down toward the floor
with his hips flexed.  The parent supports the baby's forehead with the heel
of her hand and extends a clean index finger with smoothly trimmed fingernail
for the baby to suck until the tight tongue relaxes and comes forward to
snuggle around the finger.  It may take several minutes for this to happen.
It is called the Charm hold because it "works like a charm."  As soon as the
baby's tongue relaxes, he can be gently turned right side up and immediately
offered the breast.  Carefully pull down the corner of the baby's mouth and
peek to be certain the tongue is extended over the bottom gum and wrapped
around the nipple, If the mother cannot manage this, the father or another
helper could do so as the baby nurses." (Good article, Karen!)

Warmly,
Pat Lindsey, IBCLC
Pediatrics Plus staff LC and Private Practice
Orlando, FL

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