With all due respect, Terri, I do not agree with your view that <The
breastshields do work!!!  You can also have mom use a breast pump, just
for a minute before she nurses, to help 'pull out' her nipples.  A small
electric hand pump will do the trick.>

My impression is that shields during pregnancy serve only to keep the
pressure of clothing off of the nipple while it decides (hormonally and
developmentally) to do what it's going to do. So while I would not go so
far as to say they have NO value, there is absolutely no vacuum involved,
as they are ventilated.

Many, many years ago, I wrote an article on directions for the use of
vacuum to prepare inverted or retracting nipples prenatally. Some mothers
need much, much more preparation prenatally so as not to lose valuable
time after the birth of the placenta and the resulting hormonal changes
in the consistency of the breast, plus any edema superimposed due to IV
fluids that do their share to distort nipple function during the
initiation of breastfeeding.

I think it shortchanges some moms to use only the shield as prenatal
preparation. Inverted nipples come in many different types and
severities, and the term is also often used very loosely (and intimidates
such moms), for nipples that simply retract easily, too. This "muddies"
the semantics and each case must be individualized. One doctor in England
has even written on his method of medically inserting barbell jewelry
deep at the base of the severely inverted nipple during pregnancy to make
use of the principle of tissue expansion during pregnancy. Some of his
patients have removed the jewelry postpartum, and others have nursed with
the jewelry in place, but to date, he had had several successful results!

There is a neat little joberoo available from a retailer in Toronto. The
"nipple-puller" retails for about $5, and is made in Japan by a company
named Pigeon (and probably used there fairly commonly too). I think it's
much more convenient (one-handed), as well as cheaper than the Evert-it,
or altering ordinary syringes. I have no financial interest in this
product or this company. If anyone wants to buy one or more to have on
hand for the next client(s) who might benefit, here is the e-mail, and
they give prompt service. Even the postal mail gets it to the US in just
a few days, for no extra large amount of postage.

[log in to unmask]

Given the medico-legal climate now, I always ask the mom #1, has the doc
given her any precautions about sexual activity, and  #2, wait till 37
weeks to start the treatment, since she is no longer technically
considered premature at that point. One of the side effects in research
using the breast pump to induce labor was rapid arrival of a copious milk
supply with little or no engorgement, and I have found that these moms
who prepare their nipples with vacuum prenatally also notice some of that
kind of benefit.

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

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