Annie Peterson,

        I strongly disagree with your views on nipple confusion.  Yes, all
babies come out wanting the breast (although they may not always know what
to do with it).  But, why is it that after one bottle, some take up to 3
months to go back to the breast? And, realistically, how many mothers are
willing to struggle for that long?  Nipple confusion exists.  Do you want to
tell all moms, "Sure, it's ok if you let the ababy sleep all night in the
nursery.  If they give your baby a bottle so you can 'rest,' you won't have
any problems because there is no such thing as nipple confusion.  Oh, by the
way, it may take your baby 3 months for baby to latch on again. But that
really isn't a problem, now, is it?"
        I fell most LC's know bottles have their time and place.  However,
mothers need to know there are alternatives that may not interfere with
nursing as much such as syringe, cup or SNS. Of course, these are all meant
to be as temporarily used as possible.  Our goal as an breastfeeding
assistant, in whatever capacity is to preserve BREASTfeeding.  To deny
nipple confusion will do a grave injustice to nursing moms.
        To address your other issues, a mother returning to work- the baby
should have been nursing well enough that he prefers mom over a bottle (not
the other way around).  I would not call this situation nip. con. as baby is
missing mom and returning to the breast when she returns home.  One other
thing, inverted nipples should be resolved (everted) by the return to work.
If not, there would surely be feeding difficulties along the way (assuming
mother has worked with inverted nipples for 6 weeks or longer).