I'm nomail but thought I'd send an update.
I wrote in some months ago asking for any ideas at all to help a mother
pregnant for the 3rd time.  She ended up pumping for a few months for each
of her first two babies as they never successfully breastfed.  She had
severely inverted nipples which came out during pumping but popped back in
very quickly.  She worked with hospital nurses & LC during each hospital
stay but with no luck.  She was very discouraged but wanted to try again --
she asked if there was any surgery she could do to fix her nipples.  (She
also has pretty low body image / self-esteem and feels deformed.)
On top of everything else it turned out this time she was having twins and
the prospect of getting *two* babies -- probably smallish early ones -- to
deal with her nipples was pretty daunting.
So I asked for help here on Lactnet, and was told to consider the Avent
Niplette device.  I was very doubtful, as I am very wary of gadgets and I
don't much like the idea of altering the client's body, preferring to work
on skills and attitudes.  But it seemed worth a second look in this
instance so I got the information and gave it to the mother and her
physician.  The mother wanted to try it and her doctor was supportive (he
was the one who called me about her when she came in for her first prenatal
visit this time).  We started on this whole path early enough so that she
was able to use the little suction cups for about two months before she
reached her 7-month mark where they recommend stopping.
She did not have problems with contractions or early labor (though despite
all instructions and warnings, written and spoken, she started out using
them at full suction for 12 hours/day! and had to back off due to soreness,
surprise surprise).
Her nipples everted more and more over several weeks, and maintained their
"out" position for longer and longer in between uses.
By the end of the 7th month when she discontinued use, she found that they
were usually out.
After she had stopped using the cups for a while the nipples tended to go
back in, but they would evert again readily if they got cold, so we were
confident that a chilly washcloth would quickly bring them out if needed
for nursing.
At 35 1/2 weeks, two weeks before a scheduled c-section for two breech
babies, she went into spontaneous labor and had a c-section that
night.  The babies were a 4 lbs 15 oz girl and a 5 lb 5 oz boy.  The girl
was a little slow to start breathing but then did fine; the boy needed a
few hours of oxygen but at about 8-10 hours was stable and the physician
brought him in to be put skin to skin with his mother.  He latched
spontaneously and with no fuss or difficulty at that time, and nursed well
for around 10 minutes.  (Clever boy -- the doctor had been just about to
give him some sugar water because of a concern he might be getting a little
dry after the O2.)  The girl was more inclined to be sleepy and did not
latch for several more hours, which made the mother very very jumpy.  We
kept reminding her this was not a replay of her previous experience but was
probably just a very young small baby taking a while to get
going.  Yesterday evening at 17-18 hours of age the baby girl latched and
nursed for several minutes.  She had also just urinated, and after nursing
she urped up quite a lot of mucus, so maybe a tummy full of amniotic fluid
and mucus was more an issue than her age and size.  Both babies continued
to nurse through the night and both are pooping and peeing appropriately
(I'm not at work but called for an update).
        The mother's nipples are wide (maybe 3/4" across the face, wider for the L
one), bumpy and irregular, not very everted, surrounded by a sort of narrow
groove or moat, very stiff and dense in texture, and when the areola is
compressed in a standard manner they still pop immediately and deeply
inwards instead of outwards; but it is possible to make them stick out
fairly well by doing the "nipple sandwich" and pulling back strongly.  Not
that the mother is doing that -- the babies are just latching on their
own.  (She says she wants very much to breastfeed, but after months of
frequent visits with me remains extremely resistant to any measures that
make her uncomfortable, including nudity, skin to skin contact, the
football hold, the cross-cradle hold, and having people offer to help
her.  In other words she is very willing to alter her physique -- at least,
by mechanical means -- but has no interest in changing in any other ways to
accommodate her newborn babies.  This bothers me, can you tell?  She also
has a huge family and there were people in the room all day long
yesterday.  I think the baby girl would have nursed sooner if we could have
kicked out all the partying folks and paid attention to what needed to be
done when it needed to be done.)
        Funny thought -- if the babies had big mouths and could actually get their
gums well back on the areola and compress it, I think there might be
trouble with retraction of the nipple; but they are so small that about all
they get into their mouths is the large nipple itself -- which thank
goodness is working surprisingly well: not hurting her at all, satisfying
the babies, and their output is good.  By the time they can grasp behind
the areola, hopefully they and their mother will be so good at this that it
won't faze them.

        Anyway -- a gadget that worked!  Whether she breastfeeds for a short time
or for weeks and months, she has experienced successful breastfeeding
initiation for the first time, and I really don't think it was likely to
happen without the little suction cups.  As I see it they accomplished the
following: they gave her much more confidence that she would be able to
breastfeed; they gave these small babies a much better target for
successful latch than her deeply inverted nipples would have, without a lot
of fooling around with pumping and panicking because the babies wouldn't
latch before the nipple popped back in; and the gradual eversion of the
nipples prevented the pain she would have been likely to feel if her babies
*had* latched successfully and then she'd had to nurse two of them round
the clock with nipples that were still to a great extent "tied" back and
would be ruthlessly stretched -- I've heard that this can make for a very
painful couple of weeks.

I don't know what I would do if I saw a mother who was still in
mid-pregnancy and who had very inverted nipples but who was not worried
about them or was unaware of the potential for problems.  So far this is by
far the most extreme case I've seen and she was already as worried as she
could get, so I figured she had nothing to lose but some money.  It's a
non-trivial sum, but so far it looks worth it.

Elise (still nomail)
LLLL, IBCLC
Bath, NH

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html