Hello All-
I posted this already a couple of months ago, and got only one or two
responses.  I was talking with Catherine Watson-Genna at ILCA and she shared
some great ideas (thanks, Catherine!) and suggested I re-post with a
catchier subject heading.  So here goes:
I am writing to ask your help in thinking about a client who is 28 weeks
along with a twin pregnancy.  She has had all three of her other children
with our practice, and has nursed each of them for about a year.  She has
bilateral inverted nipples.  One nipple everts fairly easily with suction,
and after trying unsuccessfully for several weeks to evert both nipples
during her 1st lactation, she has always just used one breast and her
children have all thrived.  Case notes show she used a small amount of ABM
supplement with the first child, and for only a few weeks.     Ideas that
have been offered so far include:
*       Find out what her goals are.
*       Get in-home support organized, ASAP.
*       Is she willing to pump?  The more inverted side may have anatomical
differences that wd restrict milk production.  Best way to find out what
kind of supply initially is by pumping if the babies won't take this nipple.
Obviously needed also to bring in and maintain milk production.
*       Try a nipple shield.
*       Try everting with the inverted syringe.
*       With twins risk of preterm birth precludes nipple prep til at least
37 weeks.
*       Soft shells, not the Hobbit kind (I have no experience with these,
what does LACTNET think?)
*       Alert hospital staff to her inverted nipple situation and try to
have them avoid negative oral stimuli for these babies (vigorous
suctioning,etc)

Any other brilliant ideas?  This is a first for me as well as my client and
I would love to help her succeed.
TIA--
Martha Johnson RN IBCLC
Eugene, Oregon

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