Thanks, Barbara, for your post of ll/18/99 and for the validation of my insights, the addition of yours, and the reference. I can't wait to go get it and read it with a fine tooth comb. I have saved your post to study further and keep on file. As to the reference itself, already I have questions with the terminology: (picky, picky:):) < found that the nipple extend to 2-3 times resting length> Plastic surgery, breast cancer surgery, and medical imaging literature the world over have for years been using the term "nipple-areolar complex". Because this term is much more precise in describing what we are speaking of when we are "mentally dissecting" and assessing a good latch, I encourage everyone in the lactation field to add it to their vocabulary when precision is important. IMHO, WE, of all professions, should be using this word in our literature, our certification examinations, and in our scholarly discussions and consult reports! Of the literally more than 10,000 pairs of (or 20,000 individual) nipples I have palpated and/or gazed closely at, sometimes with a magnifying glass, in 40+ years of working with nursing mothers, I could count on the fingers of one hand the NIPPLES that I believe, alone, might be able to extend 2-3 times their resting length. I think to state it this imprecise way is to muddy the waters of our own understanding, and worse yet, the understanding of all those other HCP's who have such little insight as to take it literally. It also tempts us to muddy the waters of our clients' understanding. If ANYTHING were to make a mother feel inadequate, I would think it would be to tell her that we expect her NIPPLE (that small and very sensitive and personal projection which is all she has ever seen protruding from her breast, the mammilla proper, or nipple button, as I and my friends call it) to extend (read: ST-R-E-T-C-H) 2-3 times its length while in the baby's mouth. What I believe extends to 2-3 time the resting length of the nipple (button, per se) is the nipple-areolar complex. This is a 3 dimensional concept I can illustrate very clearly by asking you to imagine using an ice cream scoop, starting at the edge of the areola (or perhaps somewhere inside of it in the case of someone with a huge areola). As you scoop it spherically downward and circle back up to exit at the opposite side, you have in your imaginary scoop the nipple-areolar complex. It contains not only the nipple and the skin and muscles of the areola, but the milk sinuses and the milk therein, the connective tissue and perhaps fatty tissue between them and beneath the nipple, plus the galactophores (the ducts leading from the sinuses outward to and through the nipple), the blood and lymph vessels, and of course, in many early postpartum mothers who receive labor interventions, any excess interstitial fluid bloating and distorting all that tissue and resisting the latch forces. I like the explanation Felicity Savage King gives in her excellent, clearly illustrated handbook "Helping Mothers to Breastfeed" , p.12-13. "Stretching the breast tissue to form a teat- A baby does not take just the nipple into his mouth. He takes a mouthful of the areola and the breast tissue beneath which contains the lactiferous sinuses. The baby must pull out or stretch the breast tissue into a "teat" that is much longer than the "resting" nipple (Illustration 6b.) THE NIPPLE FORMS ONLY ONE-THIRD OF THIS TEAT. (Emphasis [not shouting] mine.) You can sometimes see the long, stretched breast tissue for a moment when the baby stops sucking." While in the US, "teat" is almost exclusively used in relation to dairy animals and in the UK and elsewhere, to refer to a rubber nipple for a feeding bottle, still, semantically speaking, I prefer the accuracy she conveys in her explanation rather than the quote from the article above, and if I am remembering correctly, also stated that same way at least in the 1st edition of R & A. I also have a problem with the term "tethered", but I will save that for another day when I have read more and thought about it in more detail. Barbara, I can't tell you how much I appreciate your style! Now will someone please compose a limerick or a haiku or something with this punch line? ". . .the nipple is only the tip of the teat!" Jean ****************************************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ___________________________________________________________________ Get the Internet just the way you want it. Free software, free e-mail, and free Internet access for a month! Try Juno Web: http://dl.www.juno.com/dynoget/tagj. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html