Nikki writes:

<Two studies, Alexander and the MAIN Collaborative  Trial, that looked at

treatments for inverted nipples in pregnancy found that  using breast
shells 
in pregnancy were a factor in reduced breastfeeding  duration. The moms
that 
breastfed the longest were the ones who got no breast/nipple treatment in

pregnancy.>

Yes-simply because the great majority of mothers need no breast or nipple
treatment.

<I don't know of any evidence that supports the  use of this product>

Nor do I. I just know that inverted nipples come in many different forms,
and that congenital ones stem from many different degrees of arrested
development, sometimes unilateral, sometimes bilateral. Unfortunately,
the general effect of the two articles has reinforced the practice of
many to avoid assessing the protractility of nipples prenatally and/or
completely ignore inverted nipples. They subscribe to the theory "if you
can't say anything nice, don't discourage the mother by saying anything
at all". They often do this in the mistaken hope that "hormones will
straighten it all out in the last trimester" or that somehow the LCs will
figure out a way to make breastfeeding work after the baby is born. 

Each situation is individual. I think there is a great deal that can be
done in the way of prenatal teaching and planning for management of
Lactogenesis II and the initiation of breastfeeding, and possible
intervention with a breast pump after 37 weeks, and if need be, putting
the mother in touch with web resources for EP mothers. And on the heels
of our discussing using our own breasts to some degree in demonstrations,
to me, if the mother is willing and eager to learn, there is absolutely
no teaching aid more valuable than kinesthetic teaching on the mother's
own breast.

Just my $.02.  Three "strikes" and I'm out for LN today!

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

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