Hi everyone.  I am a nursing student from Maine and am researching
treatment options for women with inverted nipples who wish to
breast-feed.  I became appear of and interested in this subject after
reviewing a particular cts. (she had inverted nipples) breast feeding
history.  This primip had decided early on in her pregnancy that she
would breast-feed but unfortunately she was unsuccessful and began
bottle feeding (although with expressed breast milk) within one week
of the baby's birth.  This Mom states that she was extremely
frustrated with feeding attempts and felt that she was "starving" her
baby.  She was pleased that she could provide breastmilk for her baby
through pumping and bottle feeding but regrets the loss of a breast
feeding relationship. This Mom received prenatal care, during which
she was asked if she was planning to breast-feed, but can not recall
ever receiving general breast feeding information or a breast exam.
During her 2 day pp hospitalization she was referred to a lactation
consultant who suggested everting nipples with syringe or pump before
feeds.  This LC told the ct. that this "issue" may have been avoided
had her OB discovered and advised her on treatment options for
inverted nipples during pregnancy.(this OB by the way had reportedly
hosted several breast feeding inservices in his office prior to this
situation, taught by this very Lactation consultant!)

I have done much research (including this listservs archives) and have
found conflicting opinions on the efficacy of prenatal breast feeding
education, breast exams, and treatments for inverted nipples.
Proponents argue that anticipatory guidance is helpful in that it
increases breast feeding duration and decreases feelings of fear,
hopelessness, and frustration during the early pp period.  Most have
reported successful outcomes for mothers who have used shells,
Hoffmans exercises, or syringe treatments during the last trimester or
after birth.  Opponents argue that these rxs are not effective in
increasing breast feeding duration (and may even reduce breast feeding
rates at 6 wks pp), and may stimulate preterm labor (in the case of
Hoffmans exercises due to nipple stimulation).  Many women in one
study, who used shells and Hoffman's exercises, reported that they
"did not like" these treatments or were "embarrassed" by them (MAIN
Trial Collaborative Group, 1994).  There are also many seemingless
neutral articles stating that breast feeding education (of any sort
not necessarily those with increased risk for feeding problems)
programs have not resulted in significant differences in breast
feeding behaviors between treatment and control groups.  These
articles stress the importance of education, support, and skilled
assistance during the postnatal period.

I would like to hear what you think about all of this.  Insights,
opinions, and clinical experience/expertise are all welcome.
Specifically, what breast feeding education/treatment practices have
you seen employed and what have the success rates been? Do you feel
that prenatal treatment for inverted nipples lowers breast feeding
success rates?  Is it possible that lower rates could be attributed to
emotional ambivalence?  Has the possibility/thought of preterm labor
ever been an issue?  What are your experiences with postpartum breast
feeding support and education?  Do you think is it adequate,
available, and accessible for new moms? What are you experiences with
multips who have inverted nipples- do they require additional
treatments with each pregnancy?  Are OB's/physicians in your area
trained in breast feeding counseling?    If so, do they practice the
technique effectively? If no, what are you opinions as to why not?
Thanks in advance.  Valerie Cook

References

 Hill, P.  (1987).  Effects of education on breast feeding success.
 Maternal Child Nursing Journal, 16 (2), 145-156.

 Jones, D.  (1984). Breast feeding problems.  Nursing Times, 80 (33),
 53-54.

 Kesaree, N., Banapurmath, C.R., & Shamanur, K.  (1993).  Treatment of
 inverted nipples using disposable syringe.  Journal of Human
 Lactation, 9 (1), 27-29.

MAIN Trial Collaborative Group.  (1994).  Preparing for breast
 feeding: Treatment of inverted and non-protractile nipples in
 pregnancy.  Midwifery, 10 (4), 200-214.

McCandlish, R. & Renfrew, M.  (1991).  Nursing Times, 87 (38), 40-41.