Winnie wrote:

<When a mom uses the shells to bring out flat or inverted nipples,
the hole has to stay centered over the nipple if it has any chance
of making a difference.  However, the more a mom "needs" the shells
for this supposed purpose, the less likely they are to stay "on
target".  Unless she somehow glues them to her breast (ouch!), they
tend to shift in the bra.  She may wind up with the plastic pressing
on the nipple instead of the hole.>

True confession here! In my obsessed thinking about the value of Reverse
Pressure Softening, I recently wondered out loud in our WIC office about
the effect of the special Medela shells that have a built-in inner soft
plastic shell.

The size of the soft-rimmed hole is about midway between the sizes of the
prenatal and the postpartum Hobbit opening. (A Kaiser Permanente, CA LC
once said they love them out there.)

My colleague assured me she had a set in her car.
I had a hunch that they might be more apt to encourage interstitial fluid
to collect in the area of the opening, and thus, perhaps cause more, not
less edema over the areola.

So, wondering about the comfort, etc., I talked her into bringing them
in, and I tucked one in my bra on my 70-year-old-definitely-not-engorged
breast. I went about my business, making phone calls and charting, etc.

Half an hour later, I began to pay attention to a distracting stinging
feeling and a referred stinging way up near the tail of Spence. I decided
to check it out.

And lo, despite lifelong eversion, it had, in fact, somehow slipped. An
edge was trapping part of the nipple! Not to be outdone, I tried it, more
carefully, on the other side for a half hour, with no discomfort.

But I formed a definite impression (literally and figuratively) that had
there been excess interstitial tissue fluid, it would have tended to
gather in the general area of the areola, making it more difficult, not
less, for the sinuses to receive compression from a baby's tongue. (I
recently missed a good opportunity to test them on a mother who was
supergengorged, though!)

I once used the postpartum Hobbits on a 6 week postpartum mom whose baby
had developed a "yanking" habit and had literally made numerous tears at
the base of her nipples.

48 hours of air to the nipple, and learning to assert her "boundaries" to
her baby, in regard to latch, and voila, they were healed. I attributed
it then to the air. In retrospect, I am convinced it was teaching her
baby "I am the mistress of my body! NO YANKING! There are the limits I
will tolerate at the breast" that made the difference.

Back in my hospital practice days, I remember being present when a very
fair-skinned mother dropped her bra flap and took off a Hobbit with the
PRENATAL inner part in place, It was very obvious that her nipple was
cyanotic.

If took but a few minutes for the circulation to renew the oxygenation of
the skin tissues, and, at least at that nursing, I could see no ill
effect.

But it made wonder how many darker skinned mothers would have escaped my
notice had they tried to use the prenatal Hobbitt in the postpartum
period to protect damaged nipples and encourage eversion.

I long ago discarded any illusions that shells "draw" nipples out. But I
still am open to the possibility that they at least keep the bra from
pressing on them if they want to come out. But as Winnie says, keeping
them on target definitely needs to be addressed!

Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA



I hope someone who has access to numerous postpartum patients and a
closeup camera would be curious enough to do a photographic follow-up of
some of their moms if they routinely use any type of shells just because
they are convinced they help. A picture is often worth 1000 words.

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