Breast Feeding -BF- Counselling for Retracted Nipples

Jayendra R Gohil, Prof. MD.
     Retracted or inverted nipple is widely believed to cause breast feeding inadequacy. This type of nipple is caused by short ducts and fibrous bands pulling and binding or tethering the areola to subcutaneous tissue. A retracted nipple can be pulled back but inverted cannot be. An article in Indian Pediatrics mentioned retracted nipples, as an anomaly hindering breast feeding, and a novel treatment- sucking by husband  is mentioned. A ‘syringing’ suction treatment has also been devised [J Human Lactation]. These treatments are offered before and after delivery.

   Breast feeding is made possible by holding the baby to a proper ‘position’; resulting in good

latching & attachment, followed by coordinated reflex actions by baby.

   As per definition and as a fact a baby latches onto areola and not nipple. So a small nipple or nipple retraction does not come in the way of a baby’s ability to latch onto areola to breast-feed. However, if baby has small mouth (preterm) or small mandible (micrognathia), and nipple is large(r) it may choke the baby.

   This has been corroborated in IMNCI, WHO manual where no mention is made to treat, care or even recognize flat, retracted or inverted nipples; rather they have placed emphasis on Breast engorgement and 'improper positioning’ as cause of breast-milk ‘not coming’ or ‘baby not sucking’.
   The ‘Navajat Shishu Suraksha Karyakram’ (NSSK- Hindi) from health department of India Government, Delhi and similar Basic Newborn Care and Resuscitation Program of Indian Academy of Pediatrics, Bombay mentions that flat or short nipple does not cause breastfeeding problems; however inverted nipple should be recognized and mother assisted antenatally.

   Proper counseling to mother after delivery should be- ‘Do not worry about (small) size of nipples, baby anyway is going to take areola in mouth and draw milk out from ducts behind nipples, with the help of proper positioning. Only nipple sucking may cause sore nipples and breast feeding problem. Before delivery, treatment counselling may be advised with the reassurance that her retracted nipples, even if uncorrected by the time of delivery, shall not lead to any breast feeding problems.

     By telling mother (her nipple is defective), leads to anxiety; less hormone (oxytocin) secretion and BF failure. So if a baby is not breastfeeding due to insufficient milk or due to some problem, then certainly the problem is not the retracted nipple, but it lies in most of the cases in 'incorrect position' or 'faulty beliefs or assumptions'.

    A well conducted RCT in BMJ even recommends to abandon the practice of diagnosis of flat/retracted nipples, to avoid such anxiety.!!

Goals Are Always Achieved

Jayendra R Gohil

I am writing this from India.... after a report of a flamboyant owner's company performing poorly in air-line sector.  What has happened is blamed on global factors, gas prices, cheap fares etc. However.......

What is a goal. ? For a company- customer, shareholder, employee service and a higher purpose eg to make life easier or to free sick from illness or to prevent illness are generally the stated goals as part of mission statements.

I will tell you a story of building a bridge. After 1 year the bridge was washed away during floods with loss of lives and money and time. Still I say the goal was achieved; you ask how the goal of building a bridge to serve community for next 75 years was achieved when clearly it was washed away in first monsoon. But my dear, the goal was achieved and how, because the stated public goal was not the goal the officers and builders had in mind. Their hidden agenda (goal) was to make money and that they achieved. So the hidden goal or agenda was not aligned with the publicly stated goal. But the goal that was hidden as their agenda and was aligned to their true feelings and desires was achieved. So it is, so true everywhere.

You build an airline to ferry passengers safely and reasonably or is it to mingle with beautiful ladies.? You build a sports team to get an eye-candy actress or to advertise your brand or to really promote sports.? Why a political party at centre did not last long after defeating a very strong lady ? Because, the goal was not to give a better life to people of India for the next 5 years. Agenda was just to defeat her and thereafter; after defeating her, nobody knew what to do; this is simplifying it a lot, but you will get my point. In tennis the woman player really wants to excel at the game or just wants to be famous.? Getting both is not a bad thing and is in fact a side benefit one must enjoy and live with or learn to live with. But when getting famous is the only agenda then the game suffers. In hockey and other sports many times the agenda is not to be the champion but simply to defeat the Neighboring country team; and having done that players do say – we feel we are on top of world, we feel as if we have won the Cup/ Trophy. No wonder then that subsequent performances are dismal.

It is true for students too. Is he enrolling to the college to pass the years away or to benefit him, his family and the society he lives in. If former then he may pass out from college even as a doctor but he will not excel at being a doctor and may be miserable.

            It is true in starting families too. Do you marry to create a strong family to carry onto next generation; or do you marry to marry a beautiful (fair skin in India) girl only. Then strong family will not be there and once the skin-deep beauty goes away misery will be there for all.

As I said earlier having both goals (goal and agenda or goal and side benefit) is not a bad thing nor is it impossible. But it should have been your inner soul’s agenda aligned to publicly stated goal from the beginning. However in some cases you can correct your course and align your agenda and goal midway through a project too.

            If the goal is getting Osama only, then terrorism will not be wiped out. If the goal is to wipe terrorism then it may be controlled. If the goal is better life for people of Taliban areas then only terrorism will be truly wiped out. If the goal is to win election on terror propaganda then terror will not go away.

            Next time your road comes to an end at a river bank, think of building a bridge; or building a bridge and make reasonable amount of money due to you, but do not think of only making money.!!
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Dr Jayendra R Gohil, Professor of Pediatrics, Madhavjyot, Bhavnagar- 364002 India