I would like to second Jan Barger's comments regarding flat nipples
following lengthy epidurals esp with Pitocin use.  I see moms
immediately post partum and at postpartum consults for problems.  It
has been my experience that the problem begins with latch difficulties
from _dare I say_ "iatrogenic" flat nipples and leads to an
engorgement state by day 4-5.  Many moms I see with flat nipples
following epidruals and/or pitocin say "it wasn't like this before
delivery."  I just helped a mom today whose husband reported being
embarrased by the way his wife's nipples showed through her clothes
during pregnancy ;}  -- after a 20 hour labor with 12 hour epidural
use and pitocin, her nipples were flush with her areola.

It's scary to think how we often only see our little part of the
picture in healthcare.  Interventions often lead to more interventions
and few people are assessing the final pile of problems at the end of
the slippery slope.  Has anyone read the book MEDICAL CHOICES: MEDICAL
CHANCES?  I cannot recall its physican author at present --it's about
10 years old.  Great book -- it makes you step back and look at the
whole picture -- it endorses approaching healthcare from within a
probabalistic as opposed to a mechanistic paradigm.  It really makes
you think.

On the bright side - and back to the subject - try increasing skin to
skin contact for these babes before other interventions (esp.
bottles).  I've seen babes who were absolutely unable to acheive a
latch before, either self attach or come very close and do great with
help after about 30-45 minutes of laying between mom's breasts.

Best Regards
------------------
Glenda Deahl, RNC, ICCE, IBCLC