Barbara,

Thanks for your reply. Your post, as always, shines much light on the
problem. I recognize this as a challenge for our specific profession.

<The words we assign to the part of the breast
that the baby is drawing into the junction of the hard and soft palates
is
another one of those indistinct, or fuzzy terminology areas.  We prob. do
need either a better word than "nipple", or we need to accept that it is
a
shorthand term which does, of course, imply the nipple and underlying
tissue
plus some areola.  This "teat" that is formed under suction (if mother's
tissue is sufficiently elastic to allow it) does extend to at least twice
it's resting length.  We have good evidence of this in the ultrasound
work
of Smith, and also in Peter Hartmann's recent work.  I certainly agree
that
better examination of the breast plays into the evaluation of why the
breastfeeding isn't working.  We have the dyadic interplay, and typically
there are contributions from both sides that influence success, failure,
and
determine the sorts of compensatory strategies moms and babies employ.>

As our physiological insights grow, we need to redesign our semantic
labels. Familiar terms have their place, particularly with new parents,
but clarity beats fuzziness in other situations. "Nipple" implies many
things to many people, and we can do better than imply in professional
discussions.

I propose that we need to create some new "shorthand", rather than using
"old goatskins for new wine".

While the word "teat" has been somewhat helpful to my thinking, its
definition is not universal. As I understand it, in many countries, it
refers to the rubber nipple used on a bottle.

To my U.S. indoctrinated mind (and to those of my clients), it is a
veterinary term referring to dairy animals. Both usages denote a hollow
cavity filled with milk, a flawed concept when applied to the human
breast and its use as a feeding tool.

One of my stock lines (when teaching fingertip extraction to mothers), is
"You are not made like a farm animal. There is no milk in the nipple. It
is waiting in tiny balloons beneath the circle. There is no 'farm animal
forward' to it."

For professional communication, I have been using the terms
"nipple-areolar complex" and "subareolar" for two main reasons:

#1  They give a much more accurate and distinct
      mental picture.
#2  These terms have already been in use for
      several decades, around the world, by plastic
      surgeons, breast cancer surgeons, pathologists,
      radiologists, etc.

In essence, they are already part of a common language that certain
physician specialists have created and are using regularly in their
literature which is read by other physicians, especially family practice
physicians and medical students - physicians of the future.

I would like to see us adopting them for use in professional lactation
consultant communication with physicians and in professional literature,
as well as communication among ourselves and with nursing staffs, etc.

This takes advantage of any familiarity with the terminology and extends
any already formed concepts from the highly researched and published
realm of breast disease full circle back into the realm of normal
physiological breast function.

In the future, those two fields of study need to be seen as more of a
continuum, involving the question "Which came first-the chicken or the
egg? Physiological use or non-use of the breast has direct connection
with breast disease rates.

Use of these terms could add to our own credibility as a profession, and
could help elevate our specialty as worthy of more serious study in
health care education of all disciplines.

We can use these concepts where "the rubber meet the road." This will
allow us to discuss and define these issues more meaningfully within our
own profession.

It will also help us dialogue with other professionals about this half of
the equation of latch, especially in the newborn period and in
special-needs baby situations.

Shorthand, in the form of acronyms, is now commonly used. One that comes
to mind is MER, which was proposed some years ago to represent a more
formal professional term to replace the veterinary and/or lay term
"let-down reflex".

About that time, I made a shortlived attempt at writing up some of my
ideas for a professional publication. I was perhaps too easily
discouraged by the first reaction of the editor about creating
"unnecessary jargon" by using several shorthand
terms I created for these concepts.

Perhaps the time is now riper for such concepts and acronyms. I propose,
at least for internal use in our own profession: "NAC" for nipple-areolar
complex and "SATR" for subareolar tissue resistance.

Attaching better "handles" to these concepts, would enable us to re-order
our thinking and improve our care for both normal and complicated
situations.

Effective milk transfer without trauma or undue effort is inherent in the
basic anatomic design of the NAC.  Efficient suckling is a reciprocal
tissue interaction, and the degree of SATR as a crucial factor is not
fully appreciated.

If this sounds like a mission or a crusade, I believe it is. I'd like to
hear reactions both pro and con from others.

Jean
******************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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