Sarah Barnett, Nothing needs to be done prenatally, except to be seen by an LC to be educated as to expectations after the baby is born. Also, the person should go through a BFC. for education. A study was done by Alexander, Grant, Campbell, "Randomised controlled trial of breast shells and Hoffman's exercises fro inverted and non-protractile nipples", BMJ, 1992 and showed shells and exercises are not effective for inverted/nonprotractile nipples. Unfortunately, we use to suggest to begin wearing the shells the last trimester. What are we telling these moms? They have a problem and they need to wear these devices to make things work. What I have found very effective and why now Medela in their instructions for flat/inverted nipples will read " Begin wearing the shells a few weeks prior to delivery date. We do not believe the adhesions are broken down by the exercises and shells. We do know that with wearing the shells, the nipple is drawn out. The idea is to begin wearing the shells prenatally and take them to the hospital. After the baby is born, if they have difficulty with latch-on, they can continue to wear the shells until good latch on. (How many hospitlals do not have shells and it is more expensive for the mother to get them in the hospital) I have spoken to several LC's and they all agree that the shells are beneficial for flat/inverted nipples in the hospital and going home. Pat Bull, RN, IBCLC The Breastfeeding Connection 754 Raintree Dr. Naperville, IL 60540 (708) 420-2172