In a message dated 97-06-11 12:59:18 EDT, you write:

> I have just been
>asked to do a memo on this for the doctors in the town and would like
>to know if anyone still recommeds doing Hoffmans, or using shells?

Hello Netters,
What I am finding, at least here in US is that most LCs and RNs are no longer
teaching the Hoffmans exercises and nipple stretching, but are still
recommending the breast shells/Hobbit shells for flat/inverted nipples.
 Medela, as I was the one that wrote up the info, states to wear the shells a
few weeks before due date.  I changed that from a few months prior to due
date because it was one more thing a mother had to do and felt guilty if she
did not start soon enough and length of time wearing them was not that
significant.  We are not sure if it truly "breaks down adhesions".  That is
why that was deleted out.  What we do know is that after wearing the shells,
the nipple is assisted in becoming slightly more protruded.  I find  that it
also helps moms in bringing the shells to the hospital where many hospital
still do not carry them.  In my clinical experience, I found that, again, the
nipple was slightly pulled out after removing the shells, therefore latch-on
of baby easier.  PS- they do not cause labor  with wear.  That is another one
of those wivestales going around.  Any other questions, you are free to
e-mail me privately.

Pat Bull, RN, IBCLC
The Breastfeeding Connection/Medela
Naperville, IL