Saw an interesting case today and wondering if anyone has any thoughts to my
theory.
Second time mom.  Rt. breast fairly large nipple and areola, Lt. nipple is
inverted and the top portion is pulled in more than the bottom. In the first
delivery attempted baby to Lt but never latched so she pumped but never got a
good supply.  So feed that baby from Rt.  Just delivered second baby 4 days
ago.  Attempted baby to Lt would suck a few minutes than pull off very
content on Rt.  Used electric pump to help pull the nipple out and to help
empty breast has not got any milk from the Lt.  When baby is nursing on Rt
the Lt will leak.
In the office today observed baby at Lt. and he would draw the breast tissue
in but no swallowing.  When we used the pump only a drop of milk was visable,
same with hand expressing.  When baby is nursing on the Rt. only small dropps
well up in the deep crease on the Lt.
My theory is the formation of the inverted nipple has obstructed most of the
openings.  Mom was engorged yesterday and now just a slight fullness, both
breast are same size.  We have mom using a nipple shield on the Lt which baby
pulls some of the nipple tissue into it and is happier to latch on and suckel
for longer periods of time with a > 10:1 suck/swallow ratio.
Has anyone observed anything similiar to this?  Thanks for any feedback.

Ann Perry RN IBCLC