Thanks, Barbara, < retracting nipples which disappear when baby tries to latch, milk sinuses which are back beyond the infant's "reach" and breast tissue which is difficult to compress and manipulate?> There has always been much more of this than anyone seems to have recognized. It finally confronts the mother and the nursery/postpartum nurses and LC's after the baby is born. I have been in that situation many times, and thought "There ought to be some way to avoid this." It presents a real dilemma as to when and how to intervene and invoke Rule # 1. Your point about weight checks (by the pediatrician in this case) is an excellent one. Red flags are obvious prenatally, and that is why I feel so strongly about prenatal nipple function assessments. I think this is important if for no other reason than anticipatory guidance about strictly avoiding rubber nipples and provision for a referral and close follow-up. I have read that the breast is but an envelope of skin. What that envelope contains is different at different times in life. Through nutritional, genetic, hormonal, disease and degenerative processes, nature restructures those tissues day in and day out with few outside clues. Many assume that a breast is a breast is a breast . . . . . . Not so. Whether or not anything can be done to improve the tissue resistance some nipple-areolar complexes exhibit during pregnancy and lactation is really still in the emperical observation/trial and error stage. I realize it is not research based. Before that time arrives, there will have to be figured in the observations of many other disciplines: plastic surgeons, pathologists on surgically removed breasts, and unfortunately, post mortem findings; perhaps radiologists' observations from mammograms and serial ultrasounds can give us some evidence about whether tissue expansion can be stimulated with intensive vacuum preparation. It is not a subject that lends itself to easy answers. < Sometimes the work of feeding with nipples like this is so increased that babies can't get to hind milk. Post-feed pumping continues to protect the milk supply and provide a source of expressed milk to use as supplement.> And this means that someone needs the expertise to recognize this set of circumstances. It means taking the time to help the parents understand that their baby is in fact still an exterogestate fetus. It means likening these interventions to a temporary "pontoon-type" bridge between pregnancy and the time when the baby is fully capable of effective milk transfer. And it means reminding them that it's worth it to the baby, and to them, and that this, too, will pass. K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA ___________________________________________________________________ Why pay more to get Web access? Try Juno for FREE -- then it's just $9.95/month if you act NOW! Get your free software today: http://dl.www.juno.com/dynoget/tagj. *********************************************** 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