Kathleen writes:' The discussions about flat nipples have been most
interesting.  In taking
the "big picture" approach, it seems that many people are opting for not
mentioning same lest such mention infer that breastfeeding will be
harder/more difficult and/or that mother will become discouraged.'

I certainly don't opt for 'not mentioning' anything!

Mothers are entitled to the same information as we have, with the doubts,
uncertainties and still-to-be-established's etc etc.  Our job is to put it
across in a way that's accessible and useful.

My point is that since we have no really certain  idea anyway which nipples
may make feeding easier and which may make it more difficult (apart from
clearly rare situations - like having no nipples, or severely malformed
ones) the routine ante-natal nipple/breast assessment is useless.

We know, from the MAIN trial (whose findings were pretty conclusive - and I
think were disseminated widely) that there was *no difference*  in bf
outcome between three possible responses to inverted or flat nipples
(shells,  rolling/stretching  exercises and doing nothing). You have just
as good a chance of bf happily whatever you do. So what is the point of
assessment?

Truly inverted nipples probably do make bf more difficult (though not
invariably) but I still don't see the point of me, the midwife, the doctor
(especially if he/she's an obstetrician!) or the mother establishing
inversion before the baby's here. Any 'difficult' nipples and breasts will
reveal themselves after the birth.

Of course if a mother has concerns about her nipples antenatally, then
naturally, she should feel able to ask someone knowledgable to take a
look....problem is, some folks think they know what they're looking for,
and  they don't!

Heather Welford Neil
NCT bfc Newcastle upon Tyne