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Managing the problem of Inverted Nipples
By
The rubber band experience
Dr Kamalendu Chakrabarti
Kolkata
I have been forced to do something I
have never done and never dreamt of doing. And I was
astonished to see the result. I want to share this
experience with all the faculty members of BPNI.
A teacher, Farida (name changed), was
referred to me by her doctor as she was having problems with
breastfeeding. Farida’s baby was 21 days old and her nipples
were unusually wide and deformed with multiple bud-like tiny
swellings. She was eager to breastfeed but her baby was
unable to get the nipple in his mouth. Farida started bottle
feeding. That led to breast refusal.
At the first instance, I tried all the
conventional methods for solving the problem. But time kept
passing and all my acquired skills become exhausted. I
started to accept my failure. My struggling with the baby,
the nipple and the mother went on for about three hours. I
was tired, disgusted and Farida’s condition was miserable. I
had been overconfident that I could solve the problem, and
now, realizing that my confidence was misplaced, I expected
the mother to leave.
Farida’s husband had been a silent
observer throughout. Suddenly he spoke out. His voice was no
way pleasant. “Why you have wasted my time? Why you have
manhandled my baby? Why have you made my wife confused and
fatigued? You should tell beforehand that it is beyond your
capacity.” He shouted.
I did not know how to deal with the
family. The primary problem of breastfeeding became
secondary. The problem became social, ethical and
professional.
I timidly asked for another chance. I
tried to make them comfortable, offered tea and snacks and
went out in the open air.
I started thinking a fresh. Instead of
thinking about the incident, I tried to think about the
problem professionally and scientifically. Suddenly one idea
came to my brain and I came back. By this time Farida’s
husband was ready to leave the place. I requested them to
give me a few minutes more. I took an ordinary rubber band,
used in daily household purpose and with permission, I ask
my lady attendant to apply the band around the base of the
nipple of Farida’s breast. Then the baby was positioned
properly and the magic began. To every body’s surprise, the
baby stated suckling and smile was visible in face of the
parents.
After seven days, they came again and
thanked me. Farida fed her baby exclusively for six month
and continued till the baby was about one year old. I
requested them for one photograph but they refused.
The incident stayed with me, affecting
me deeply. What I was forced to do as an act of desperation
in an adverse situation, led me to work on it - to find out
whether Farida’s case was merely one incident or had the
rubber band really done the magic. I stated carry it though.
Fortunately I got a few mothers with problems in their
nipple.
Radhika (changed name) was a young
mother without any breastfeeding knowledge. She had a very
unusually big breast having nipples with very ill-defined
margins. In fact, the nipples were buried underneath the
breast and Radhika herself had search them out. Only a
blurred black margin of areola was visible. After
positioning, which was very difficult, I could not made the
baby to suckle. Then I went for the rubber band. Again the
magic prevailed.
Gradually, I started using the rubber band in other nipple
conditions with success.
Here I am depicting some visuals.
Figure 1a
condition of nipple of Dipika
Figure 1b
condition of nipple of Dipika
Fig1a.b. Shows
the condition of nipple of Dipika (changed name). As seen in
the visuals, it was a clear case of gross inverted nipple;
in fact nipple is not formed. Dipika had 11 day-old baby.
She tried her best with the help of doctor to breastfeed.
But she was completely unsuccessful. She was forced to start
bottle feeding. I showed her proper positioning. I used
INVERTED SYRINGE method, (which is a standard method)
without any success. Then I went for the rubber band and the
problem was solved.
Figure 1c. Shape of Dipika's nipple with band (manually
applied)
Debashree had inverted nipple. As she had been given wrong
advice, she started bottle feeding her baby since birth,
leading to total breast refusal. INVERTED SYRINGE method was
not successful. The problem was instantly solved with rubber
band. Figure
Figure 2. Debashree's nipple with rubber band
Figure 3. Debashree successfully breastfeeding
The rubber band method
The indications of using rubber band
are
• Inverted nipple
• Huge breast with ill-defined nipple
• Distorted nipple due injury, post-burn scar, etc.
Type of rubber band
Ordinary rubber band used for small package in shops
will do. It should be washed thoroughly with soap and water.
A few bands may be put together, wrapped with a piece of
cloth and boiled for 5 minutes.
How to apply the band
Application of rubber band around the nipple is technically
is slightly difficult. It is best applied by the mother
herself.
Duration of keeping the rubber band
during feeding
As such, the rubber band can be kept for the whole
session of breastfeeding. But it is better to remove the
band once the attachment is complete and baby starts taking
the breast comfortably. It has been seen that most of the
mothers prefer to keep the band for the whole duration of
feeding. It sometimes becomes difficult to remove the baby
from breast while they are feeding comfortably. There is no
harm in keeping the band for the each session of feeding. No
mother has yet complained of pain and discomfort with band
applied. But the mother should be told to remove the band if
she feels pain.
For how many days the rubber band
should be continued to be applied
Depending on the condition of the nipple, the band is
required to be used for two or three days. Then the
condition improves and breastfeeding can be continued
normally.
Comparison between INVERTED SYRING
METHOD and RUBBER BAND
The standard method of treating inverted nipple with
Inverted syringe has some problems. The nipple does not
protrude after syringing in most cases. It has always to be
done under medical supervision. It causes pain. In case of
rubber band, the nipple stays protruded and though it is
always better to done under supervision, once the mother
learns the procedure, she may not require strict
supervision. It is not painful.
The best method is drawing out the nipple with the syringe
and then applying the band.
The risks of rubber band
There is possibility that the band might slip into
baby’s mouth. But in the twenty cases, I have used rubber
band, not a single one has slipped in.
The ordinary rubber band is probably chemically not suitable
for use. However, because firstly it is cheap and other
kinds of rubber bands are not available, secondly, the baby
is not swallowing the band and thirdly it is used for a very
shot period, the problem should be considered merely
theoretical.
Conclusion
Using a rubber band is a very simple method of dealing
with the nipple problem. I am still working on it. I am
trying to devise a simple device to better application of
band, am not able to make it due to lack of technical
support.
My intention is to make a simple instrument as given in the
figure below.
A syringe-like simple instrument as
used in Inverted Syringe method without the wide base, which
causes obstruction when slipping the rubber band over the
nipple. The base should be smooth enough not to cause pain
and injury to the breast.
Till such an instrument is available, a simple a 10 cc
plastic syringe is a very good method for certain nipple
conditions.
Finally, I worked on the issue more
methodically and got it published in the BREASTFEEDING
JOURNA, the official journal of ACADEMY OF BREASTFEEDING.
THE LINK IS: MyJournals.org - 'Management of Flat or
Inverted Nipples with Simple Rubber Bands' (Breastfeeding
Medicine) |
