Diane asks whether it is possible to have other sources of nipple trauma
resulting from bfg itself that is not connected with nipple
creasing/distortion.  Woolridge's landmark articles in Midwifery in 1986
talk about 2 kinds of primary nipple truama.  Inadequate teat formation (the
creasing, pinching phenomenon) and another type of trauma related to milk
flow problems.  He talks about how if the milk supply is low (or letdown is
slow) the baby may exert excessive levels of suction trying to get the flow
started.  This can continue to open up suction lesions on the face of the
nipple.  These tend to be more starburst shaped or circular than the typical
straight line fissure or scabbed over "stripe" caused by a compression type
trauma.  The solution is to improve milk supply and flow rate. Sometime if
the palate is very arched, I think a nipple face can get tilted up at an
unusual angle and the nipple face can rub on the palate surface.  If this is
ridged, that can be very abrasive.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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