Joanne writes:

<I would appreciate some advice from Lactneters that have encountered women
(postpartum days 1-3)  with the following issue:  Nipples that are
inverted, but evert after the first few feeds and remain everted; however,
the nipple tissue then becomes red and blistered.  Babies are transferring
milk, as evidenced by diaper counts, but moms are experiencing significant
pain, blistering and cracking.  Any experience you've had with these
patients that enabled them to continue direct BF wold be greatly
appreciated.>


My answer does not, of course, rule out dysfunction of the tongue and/or labial frenula. That having been said, in the early postpartum period in the U.S. where so many mothers get lots of IV fluid, and many times, much Pitocin, I think the following scenario is a lot more common:


First, rather than "inverted", I think the more accurate terminology would be "temporarily retracted" nipples if the mother did not have (congenitally) inverted nipples prior to and during pregnancy.


Secondly, the oft-quoted  "The nipple (including its attachment to the areola) is an elastic structure, capable of stretching two to three times its resting length" is widely misinterpreted in the U.S. It is a misquote of Michael Woolridge in "The anatomy of infant suckling", Midwifery1986, 2:164-171, in which he states (emphasis in capitals is mine)  "The nipple, WITH SURROUNDING AND UNDERLYING BREAST TISSUE, is drawn out into a TEAT . . . . . . . . . . the TEAT is about three times as long as the nipple at rest". Unfortunately, in U.S. English, the word "teat" seems to be applied only to farm animals, so it is culturally easy for us to confuse this important distinction.


I like to encourage folks to think of the nipple and areola as one entity. The nipple is inseparable from its relationship to its 3 dimensional areolar/subareolar tissue. (as in: the areola is to the nipple a lot like the hand's relationship is to the finger. They are designed and connected to work together.)  The areolar tissue will be freed to transport the nipple more deeply into the baby's mouth if the excess interstitial fluid as well as most of the fullness within the milk ducts are temporarily gently pressed back inward toward the heart, (for the slow count of 50, or more if need be) preferably with the mother in an antigravity position, 


If the areolar tissues are busy "using up their stretchability" by containing excess intersitial fluid plus subareolar ducts that may be full of milk, they cannot, at the same time, extend the nipple itself deeply into the baby's mouth toward the soft palate. The concept is one of "elasticity", meaning: even a rubber band has to reshape itself to be "skinnier" in order to spread the same number of rubber molecules out over a longer distance. 



In the first 1-2 postpartum weeks, the areola must be temporarily relieved of much of its "storage" function just before latching so as to free it to perform its "extending" function effectively. The areolar tissues must "regroup" so they can become temporarily  "skinnier"  to extend the nipple more deeply. 


kellymom.com :: Reverse Pressure Softening, by Jean Cotterman www.kellymom.com › Breastfeeding › Common Concerns › Mom


I will gladly give more references to anyone who contacts me privately.


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

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