Hi everyone. I am a nursing student from Maine and am researching treatment options for women with inverted nipples who wish to breast-feed. I became appear of and interested in this subject after reviewing a particular cts. (she had inverted nipples) breast feeding history. This primip had decided early on in her pregnancy that she would breast-feed but unfortunately she was unsuccessful and began bottle feeding (although with expressed breast milk) within one week of the baby's birth. This Mom states that she was extremely frustrated with feeding attempts and felt that she was "starving" her baby. She was pleased that she could provide breastmilk for her baby through pumping and bottle feeding but regrets the loss of a breast feeding relationship. This Mom received prenatal care, during which she was asked if she was planning to breast-feed, but can not recall ever receiving general breast feeding information or a breast exam. During her 2 day pp hospitalization she was referred to a lactation consultant who suggested everting nipples with syringe or pump before feeds. This LC told the ct. that this "issue" may have been avoided had her OB discovered and advised her on treatment options for inverted nipples during pregnancy.(this OB by the way had reportedly hosted several breast feeding inservices in his office prior to this situation, taught by this very Lactation consultant!) I have done much research (including this listservs archives) and have found conflicting opinions on the efficacy of prenatal breast feeding education, breast exams, and treatments for inverted nipples. Proponents argue that anticipatory guidance is helpful in that it increases breast feeding duration and decreases feelings of fear, hopelessness, and frustration during the early pp period. Most have reported successful outcomes for mothers who have used shells, Hoffmans exercises, or syringe treatments during the last trimester or after birth. Opponents argue that these rxs are not effective in increasing breast feeding duration (and may even reduce breast feeding rates at 6 wks pp), and may stimulate preterm labor (in the case of Hoffmans exercises due to nipple stimulation). Many women in one study, who used shells and Hoffman's exercises, reported that they "did not like" these treatments or were "embarrassed" by them (MAIN Trial Collaborative Group, 1994). There are also many seemingless neutral articles stating that breast feeding education (of any sort not necessarily those with increased risk for feeding problems) programs have not resulted in significant differences in breast feeding behaviors between treatment and control groups. These articles stress the importance of education, support, and skilled assistance during the postnatal period. I would like to hear what you think about all of this. Insights, opinions, and clinical experience/expertise are all welcome. Specifically, what breast feeding education/treatment practices have you seen employed and what have the success rates been? Do you feel that prenatal treatment for inverted nipples lowers breast feeding success rates? Is it possible that lower rates could be attributed to emotional ambivalence? Has the possibility/thought of preterm labor ever been an issue? What are your experiences with postpartum breast feeding support and education? Do you think is it adequate, available, and accessible for new moms? What are you experiences with multips who have inverted nipples- do they require additional treatments with each pregnancy? Are OB's/physicians in your area trained in breast feeding counseling? If so, do they practice the technique effectively? If no, what are you opinions as to why not? Thanks in advance. Valerie Cook References Hill, P. (1987). Effects of education on breast feeding success. Maternal Child Nursing Journal, 16 (2), 145-156. Jones, D. (1984). Breast feeding problems. Nursing Times, 80 (33), 53-54. Kesaree, N., Banapurmath, C.R., & Shamanur, K. (1993). Treatment of inverted nipples using disposable syringe. Journal of Human Lactation, 9 (1), 27-29. MAIN Trial Collaborative Group. (1994). Preparing for breast feeding: Treatment of inverted and non-protractile nipples in pregnancy. Midwifery, 10 (4), 200-214. McCandlish, R. & Renfrew, M. (1991). Nursing Times, 87 (38), 40-41.