Winnie wrote: <When a mom uses the shells to bring out flat or inverted nipples, the hole has to stay centered over the nipple if it has any chance of making a difference. However, the more a mom "needs" the shells for this supposed purpose, the less likely they are to stay "on target". Unless she somehow glues them to her breast (ouch!), they tend to shift in the bra. She may wind up with the plastic pressing on the nipple instead of the hole.> True confession here! In my obsessed thinking about the value of Reverse Pressure Softening, I recently wondered out loud in our WIC office about the effect of the special Medela shells that have a built-in inner soft plastic shell. The size of the soft-rimmed hole is about midway between the sizes of the prenatal and the postpartum Hobbit opening. (A Kaiser Permanente, CA LC once said they love them out there.) My colleague assured me she had a set in her car. I had a hunch that they might be more apt to encourage interstitial fluid to collect in the area of the opening, and thus, perhaps cause more, not less edema over the areola. So, wondering about the comfort, etc., I talked her into bringing them in, and I tucked one in my bra on my 70-year-old-definitely-not-engorged breast. I went about my business, making phone calls and charting, etc. Half an hour later, I began to pay attention to a distracting stinging feeling and a referred stinging way up near the tail of Spence. I decided to check it out. And lo, despite lifelong eversion, it had, in fact, somehow slipped. An edge was trapping part of the nipple! Not to be outdone, I tried it, more carefully, on the other side for a half hour, with no discomfort. But I formed a definite impression (literally and figuratively) that had there been excess interstitial tissue fluid, it would have tended to gather in the general area of the areola, making it more difficult, not less, for the sinuses to receive compression from a baby's tongue. (I recently missed a good opportunity to test them on a mother who was supergengorged, though!) I once used the postpartum Hobbits on a 6 week postpartum mom whose baby had developed a "yanking" habit and had literally made numerous tears at the base of her nipples. 48 hours of air to the nipple, and learning to assert her "boundaries" to her baby, in regard to latch, and voila, they were healed. I attributed it then to the air. In retrospect, I am convinced it was teaching her baby "I am the mistress of my body! NO YANKING! There are the limits I will tolerate at the breast" that made the difference. Back in my hospital practice days, I remember being present when a very fair-skinned mother dropped her bra flap and took off a Hobbit with the PRENATAL inner part in place, It was very obvious that her nipple was cyanotic. If took but a few minutes for the circulation to renew the oxygenation of the skin tissues, and, at least at that nursing, I could see no ill effect. But it made wonder how many darker skinned mothers would have escaped my notice had they tried to use the prenatal Hobbitt in the postpartum period to protect damaged nipples and encourage eversion. I long ago discarded any illusions that shells "draw" nipples out. But I still am open to the possibility that they at least keep the bra from pressing on them if they want to come out. But as Winnie says, keeping them on target definitely needs to be addressed! Jean ************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA I hope someone who has access to numerous postpartum patients and a closeup camera would be curious enough to do a photographic follow-up of some of their moms if they routinely use any type of shells just because they are convinced they help. A picture is often worth 1000 words. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html