In a message dated 4/7/2006 8:31:00 PM Eastern Standard Time,  
[log in to unmask] writes:

With  regards to this...Do areolas need to be soft to  work with a  shield?  
I 
am working with a mom with very inverted  nipples,  very leathery inflexible 
areola tissue and having trouble with any  size  nipple shield staying put at 
all.There is no way it seems to  draw the tissue  into the tip.  Baby balks 
like 
crazy and is  totally frustrated as a result  till bottle appears. This woman 
is 
in  tears from wanting so much to bfeed and I  am at a loss. Thanks,  Ann



Ann, in your description of the "leathery inflexible areola tissue" I find  
this is usually due to edema.  Thanks to Jean's work I have these moms use  RPS 
and it is amazing how soft and flexible that tissue becomes where the mom  
had her fingers.
 
In your description is why I don't use a shield for these cases.  The  
likelihood of good latch or milk transfer is poor.  
I would work with this mom to use RPS than she could try a pump or her hand  
to express her milk.  I would also recommend cup feeding for this  baby.  
These moms will never have a long firm nipple like a bottle (well no  one does, 
but some moms nipples are perkier) so I would avoid these kinds of  imprinting.
Ann Perry, RN IBCLC
Boston, MA

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