>i don't think assessing for "flat" nipples means or accomplishes anything
>except for perhaps making the mother doubt her ability to breastfeed. how
flat
>they look/are before birth has little impact on the mom's ability to nurse.

You're right, of course.  The most extreme case I ever had was a mom with
*no* nipples.  That's right, *no* nipples. There were openings to the ducts
and areolas, but no extruded nipple tissue. The "front" of the breast was
smooth. Fortunately, this baby was born at home so no one told the mom that
she couldn't feed her baby with that defective equipment.

It was a most challenging case, but baby did learn to draw the areola
tissue back into his mouth and feed like any other baby. Mom suffered from
"sore areolas" at first, but just fed one side while the other grew less
sore, then switched.  Soon there was no soreness.

I wrote this up on Lactnet once and it is a long drawn-out story of the LC
trying one thing after another till at 6 weeks baby was fully breastfed.
And a story of dedication and courage on the part of the mother. Mom called
it stubbornness.

When all was going well someone asked mom how long she was going to
breastfeed, and her reply was, "As long as I want to!!!" The little guy was
still nursing at 5 years when I last heard from them.

Nipple shape is challenging sometimes, but often the most challenging part
is cancelling the indictment of "faulty equipment." "Flat nipples" is a
common observation on the part of hospital personnel. Of course, I'm sure
that the moms are asking, "Why can't my baby latch on?"  And there *must*
be an answer.

Patricia Gima, IBCLC
Milwaukee, Wisconsin, USA
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