I, too, am "de-lurking", to join the controversy over nipple assessment.
I've been reminded of the blind men describing an elephant!
I posted my "maiden message" on Lactnet 18 months ago while taking a
senior citizens computer class, preliminary to buying a computer. But
soon thereafter, my husband became terminally ill. After the gift of a
long goodbye, I am gradually resuming my former interests. Being a
"perpetual student of lactation" is high on my list. I am retired after
44 years as a maternity nurse, 24 years in a hospital (4 of those years
doing CE too), and 20 years in public health prenatal care. I currently
volunteer as a WIC LC twice a week.
I have many insights I hope to share in the time left to me. My special
interest became the study of embryonic, fetal and prenatal development of
the nipple-areolar complex as it relates to comfortable and effective
milk removal. My "scientific" camera shot hundreds of closeups. As
questions occurred to me, I searched seminal references for clues that
might be pieces I could fit into the puzzles in my mind.
"Keeping Abreast Journal" published my article "Intensive Preparation for
Inverted and Retracting Nipples" in Oct.-Dec. 1976 at least 2 years
before the article which Patricia Drazen cited here as the first
published report of suction treatment to evert nipples. The common
equipment I described is probably off the market, and I have modified my
ideas many times over the years.
I have focused my attention on NIPPLE FUNCTION, not just NIPPLE
APPEARANCE. I find the function test named after Mary Jane Otte to be of
particular value. My experiences have led me to the philosophy that every
situation is individual, and deserves an individual approach.
So, after we OFFER an assessment , "what can we do about it anyway?" For
one thing, we can start familiarizing a mother with handling her breast
AS A FEEDING TOOL. (Girls in many cultures "absorb" and "experiment" with
this knowledge as they grow up watching the breastfeeding process, while
girls in our culture are too often busy relating to Barbie or Baywatch!)
A 3rd trimester nipple assessment presents a golden opportunity to
affirm, reassure and use a mother's KINESTHETIC sense to teach a few
elementary skills useful in starting off toward a positive breastfeeding
outcome. (I am told that the upcoming issue of JHL will include one of my
tips in "Consultant's Corner") Watching body language is very
informative. I like Diane's suggestion about watching for the glimmer. I
have seen the "light bulb" go on over many a mother's head as insights
fall into place connecting up what she's heard and read.
IMHO, withholding the offer to assess DELAYS IDENTIFICATION OF MATERNALLY
BASED SPECIAL NEEDS (be THEY intervention or special anticipatory
management guidance) until the vulnerable period when a mother is
undergoing postpartum fluid shifts, sleep deprivation, perineal or
abdominal discomfort and intense preoccupation with the well-being of her
baby, who may himself have special needs, all during a shortened stay for
"taking in" teaching. (And it leaves the LC to bat "clean-up" ! )
Very early in the history of perinatal care, probably in the infancy of
ultrasound, I was privileged to hear Dr. J.D.Baum, British pediatrician
and ophthalmologist. I find his astute observation still pertinent today.
The cord and placenta are the tools of prenatal nutrition, which we
cannot see with our naked eye till they are no longer needed. The nipple
and the breast are the tools of postnatal nutrition, yet we seem to
ignore them until the baby needs them!
Off my soapbox!
K. Jean Cotterman RNC,IBCLC
32 Mello Ave., Dayton, OH 45410
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