Kathy,

1977 is a very old reference, back when BF management (and breastpumps) were anything but far, far from what has been learned since. I'm wondering if prolactin levels were even drawn then, or was this supposition on the part of the author?
 

Prolactin levels reach very high levels in a term pregnancy, and fall off within a few days, except for surges theoretically caused by stimulation slightly "after" than "at" the time of milk removal. It was once believed there was a connection between prolactin secretion and oxytocin secretion, which I would have to go back and review, but it was later proven that there is apparently no real causal relationship between the 2, and that the timing of their surges is different.


Even the time of the 24 hour day the blod is drawn, and relationship to whether drawn before or after milk removal, makes a change, and I doubt the science was sophisticated then as it is now. The information on FIL (feedback inhibitor of lactation) didn't enter human lactation literature till much later. Who knows if early, regular postpartum pumping was done?? Exact classification of inverted nipples doesn't seem to be an exact science, since there are so many different variations in inverted nipples. One author uses the terms "invaginated" versus "umbilicated". Let's hope your client has umbilicated nipples.


I have pictures of cases of several moms who developed at least some nipple eversion, (some, a lot of eversion) when the original 1940-1950 directions of Egnell himself were used (during the last 2-3 weeks before term with the OB doc's permission. Mom was instructed about observing for Braxton Hicks uterine contractions.) 


The modern double electric pump on moderate strength was used for 5 minutes 3 times a day for several days.  If no increased BH contractions, this was increased to 4 x daily for a few days and finally increased to 10 minutes (still on moderate strength) 4 times daily till entering the hospital. Both of this mom's nipples eventually turned out to be simply umbilicated. However, when she asked to have them looked at at 28 weeks of pregnancy, they both looked exactly like an earlier one, whose one inverted (invaginated) nipple never came out. 


But nearer term, using the Egnell directions for 2 weeks of this, both of hers came out beautifully, for a short while, long enough  to have latched were the baby born yet. So she was experienced in everting her nipples with the pump well before she entered the hospital for whatever managed OB care she was to be given. She did, in fact, use the pump to evert her nipples each time so the baby latched easily (despite a CS with so much IV fluid that edema could be seen in her thighs!) She went on to nurse happily, for 6 weeks, eventually without using the pump to draw out nipples. Her culture, choice to use supplements, etc. etc. influenced her to feel pride in the fact that she had nursed as long and as successfully as her (noninverted nippled) sisters in the Far East had done and she weaned deliberately and happily, sending me a picture of the baby at 6 weeks old.


BTW, the mom with the one invaginated nipple nursed on the everted nipple on the other side, and with the pump used on the invaginated inverted side, got copious amounts of milk following the MER triggered by the nursing. Due to family circumstances, once she proved to herself that her baby was thriving at nursing on one breast only (like a twin might be doing) she simplified her life and d/c pumping gradually on the invaginated side. She was still EBF at 4 months when I lost track of her.


I have a few later references in my files if you want to contact me privately.


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

 

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