Pamela, I don't think we're in conflict at all: horses for courses I
suspect. I don't disagree with you where the fissure will recur because
feeding (even well-positioned and attached) applies pressures that break
the skin open again. There are some surfaces that need to moist-wound-heal
open and some may never actually join up from the bottom to teh top (say
some mothers who have inverted nipples that evert) but instead have a new
rift valley on the nipple face, so to speak. But where this is a
positioning problem (horribly common) and not a nipple morphology (rarer)
problem, the healing is often so rapid that keeping the faces together (not
squashed) as we would with other wounds, makes for comfort after the feed
and no further breakdown during the next. I'll never forget the mother I
met in Bristol, who'd been a patient of Chloe Fisher's, who had told me
about teh amputated nipple she had developed (literally: circumferential
damage and the face sheered off altogether). She was in agony with a gory
stump and Chloe said let's get the baby on, and it didn't hurt...Mother was
ecstatic, went on feeding the baby very frequently all day and night now
she knew how to get latch right. Within 24 hours, when the mother came back
for the checkup and photo Chloe couldn't resist taking, she had that pink
new skin and no visible lesion or pain. I've seen the photo, inspected the
boobs and the nipple actually grew back from the stump it had been. It's
all that EGF and other goodies that makes skin grow...And I do think that
immobilising the edges is more comfortable: nerve ends jangle as the
surfaces move... So I don't think we're in disagreement (not that you need
worry if we are: your experience is as valid as mine. And being an academic
by training I love people who can disagree intelligently without being
disagreeable, patronising or pompous, so full marks!!!) Warmest best wishes
to you over there from us down here.. MM

Maureen Minchin, IBCLC. Christ Church Vicarage, 14 Acland St., St.Kilda,
Vic. 3182 Australia. tel/fax: 61 3 9537 2640
"Taking paths of least resistance is what makes rivers - and people -
crooked." poster in Palmerston North NZ bookshop...