Not all women have nipples of the same shape or size. Some are inverted, flat, or pull into breasts which can make breastfeeding problematic for these moms. There are factors that affect whether nipples protrude, are inverter, or lie flat. The density of your connective tissues underneath your nipples, the volume of fat in your breasts, and the length of milk ducts all play a role.
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Pregnancy can change your nipples
Keep in mind that pregnancy also have an affect on your nipples, believe it or not. Flat nipples can push out when you are expecting or during the first week after your baby is born. It is commonplace for women to worry about nursing when they have flat nipples. However, there is some good news. With a bit of patience and some extra time, nursing is possible. Remember, it is called breastfeeding, not nipple feeding for a reason. If your little one can take a good section of the breast into his mouth, fat or inverted nipples should not cause issues with nursing. Your baby’s gums and mouth must bypass the nipple to latch entirely onto your areola. As long as your baby latches correctly, breastfeeding with flat nipples should not be a problem.
How do you know if your nipples are inverted or flat?
Just by inspecting your breasts, will not give you an answer. The simplest way of checking whether you have flat nipples, is by conducting a “pinch” test. Gently squeeze the darker area surrounding your nipple (areola) about an inch behind the nipple. If your nipple does not become rigid, it is an indication of a flat nipple. If your nipple withdraws, or curves inwards, it is an indication of inverted nipples. Do keep in mind that when truly inverter or flat nipples will not stand up when exposed to cold or are stimulated.
Various types of flat or inverted nipples
- Dimpled – Only part of your nipple stands out. You are able to pull the nipple out, but it will not remain that way.
- Unilateral – Only the one breast has a flat or inverted nipple.
- Inverted – Usually various possible degrees of inverted nipples exist.
- Slightly inverted nipples – The lesser degree is referred to as slight. Babies with normal suck will most likely have not issues with getting a slightly inverted nipple out, but premature babies with weak suck might struggle at first.
- Moderate to severely inverted nipples – This is where the nipple withdraws deeply once the areola is squeezed to the same level or underneath your areola. Nipples with moderate or severe retraction might cause issues with latching or nursing, however, there are certain treatments or deep latch techniques that could resolve the issue. Breast shells could be a solution, particularly during pregnancy. Once inverted nipples are only detected after birth, treatment is still possible, however, good latching or positioning are most essential.
Techniques for making latching easier with flat nipples
Even though everyone’s experiences and opinions differ, many women have found treatments for flat or retracted nipples useful and many nursing experts continue recommending them. Nursing professionals disagree about whether pregnant moms must be screened for flat or inverted nipples and if treatments for drawing the nipples out must be periodically recommended. However, if your baby is struggling to latch onto flat or inverted nipples, some of these techniques might be useful.
Wearing breast shells
Breast shells are worn on the inside of your bra and can prove to be useful for drawing out inverted or flat nipples. They are typically two pieces that are made from plastic. The inner section has a hole that securely fits over your nipple. The compression on the tissue surrounding the nipple can cause your nipple to protrude through the hole. You can wear breast shells while pregnant. After giving birth, breast shells can be worn for half an hour or so before feeds to help extract the nipple. Do not wear them during the night and milk that is collected while wearing them must not be kept.
Useful products for everting or lengthening nipples
There is a vast selection of products for sale that can be useful since they are designed specially for everting and lengthening inverted nipples.
Using a modified syringe or breast pump
An efficient breast pump or device that helps with elongating or pulling the nipple can be used before nursing. This can also make latching a little less tricky for your baby. These devices are also helpful after birth for further breaking the adhesions underneath the nipple by putting even pressure from the center of your nipple.
Pulling breast tissue back when baby is latching
When your thumb is on top and four fingers are underneath and behind your areola when baby is latching on, you can slightly pull back on the breast tissue and towards your chest wall to get the nipple to protrude.
Stimulating the nipple before feeds
Grasping your nipple, if possible, and rolling it between the thumb and index finger for about two minutes followed by touching it with a moist, cold cloth, or ice that is wrapped in a cloth, can help with getting the nipple to stand up. However, avoid extended use of ice because numbing the areola and nipple can impede your let-down reflex.
Wearing nipple shields
Nipple shields are thick, bendable silicon nipples that are worn over your nipples. It has tiny holes in the tip that allows for milk flow. Nipple shields can be incredibly useful to help your baby with latching on and breastfeeding well by stimulating the roof of his mouth which triggers his suck reflex. You should only use nipple shield with the assistance of a lactation expert since they can lead to issues if not used correctly.
Reverse compression softening
By using your finger tips to enclose the base of your nipple and gently pushing towards your chest wall for one to three minutes before latching, can assist other fluids to be pushed aside and triggering milk flow which will make the nipple to stand up and allow easy access for your baby to grasp it.
Useful tips for breastfeeding with flat nipples
- Get guidance for positioning and latching-on
Getting professional guidance is crucial when you have flat or inverted nipples since it is essential for your baby to learn the technique of opening his mouth wide enough in order to bypass the nipple and allow his gums to close further along the breast. Trying various positions is another great way of finding the position that is best for you and enabling your baby to latch-on correctly. For some, the football clutch or cross-cradle hold gives them better control and makes it easier for baby to latch on.
- Start nursing as soon as possible and as often as you can
Do not put off breastfeeding and start as quickly after giving birth as you can, at least every two to three afterwards. This will avoid engorged breast and will give you and your baby time to practice nursing before your milk starts coming in at a rapid pace. Practicing nursing while your breasts are soft assists your baby to successfully nurse even after your breasts become firmer (usually when flat nipples are trickier to grasp).
- Aiming for a deep latch
Hold your baby close to your body when he is latching on, with his shoulder, ear, and hip in a straight line. Make sure his nose is aligned with your nipple and pull back on breast tissue to make it possible for him to latch on. It helps to tickle his lips with your nipple to get him to open his mouth wide, almost like a yawn. This is the perfect time for him to latch on. Make sure he has surpassed the nipple and is latched on far back on your areola. Your baby’s nose must be touching, but not suppressed in the breast, and his lips must be widened, resembling “fish lips”.
- Implement calming techniques when your baby becomes fussy
Breastfeeding must be a pleasant experience for both you and your baby and it must not be associated with discomfort. When your baby becomes fussy, take a break immediately and first calm him down. Swaddle, rock, or go for a walk with him. Wait until he is calmer and then give it another try.
- Using an electric breast pump
What often happens with moms that have deeply embedded nipples, instead of compressing milk ducts, the baby squashes the nipple instead. Since he cannot grasp the nipple to be correctly positioned, he will not be getting much milk and the whole experience will be painful for his mom. A double electric breast pump could be the ideal solution since instead of compressing the areola, it uses even suction from the center of your nipple to try and draw it out. With time this could assist with breaking the adhesions that prevents the nipple from protruding.
- Keep feeding on one side
Even though moms usually alternate breasts when breastfeeding, if it is easier for baby to feed from a particular breast, you can continue with doing so. You can use a breast pump for expressing milk from the side with the deeply inverted nipple until you notice the adhesions have loosened enough for the nipple to be drawn out. Your baby can still get the milk he requires from the one breast permitted that he has unrestricted and unlimited time when feeding.
- Pumping both breasts at the same time
In cases where both nipples are deeply embedded, you can pump both breasts at the same time for about fifteen to twenty minutes, eight times per twenty-four hours or more. You can feed your little one with another feeding aid until he can successfully and comfortably latch on. The time it will take to express to draw the nipples out will be contingent on the adhesion’s strength and the level of inversion.
- Nipple correction through pumping
For some moms, a single pump is sufficient to entirely draw the nipple out. However, if the nipple remains deeply inverted, you might need to continue expressing. If your nipple remains protruded after expressing, you can immediately resume nursing. When the nipples are drawn into your newborn’s mouth appropriately and he manages to breastfeed successfully, you can discontinue expressing and nurse without soreness or discomfort.
On few occasions, moms will continue feeling discomfort after the nipple was drawn out. It could be the result of radical correction to your nipple.
After nipple correction, seldom the nipple will invert again when baby pause while nursing. In such an instance you might have to stop and express again for a short while before placing your baby back on your breast. As a short-term transition to nursing exclusively, using a breastfeeding supplementer, or doing breast compressions might encourage ongoing sucking and swallowing to prevent the nipple from inverting during a feed.
What to do when your nipples are sore
Nipple soreness is common among moms for the first two weeks of breastfeeding because their inverted or flat nipples are slowly drawn out by their baby’s suckling. If the soreness does not go away after the first two weeks or becomes severe, call your local lactation expert for assistance.
What if moisture becomes trapped when the nipple inverts after a feed
If your nipple capsizes after a feed, the skin might stay moist which can result in chapping. After feeds, gently pat your nipples dry and use some emollient which is safe for nursing. You can also wear breast shells to prevent the nipple from retracting between feeds for your skin to stay dry.
What if the nipple soreness is not going away?
It does not happen often that moms experience persistent sore nipples for a prolonged time. However, it does happen when adhesions stay tight instead of stretching which creates a stress point that results in blistering or cracking.
Women with inverted or flat nipples can breastfeed with a little patience and taking time to learn the right techniques or using nursing aids that are designed specially for drawing out nipples. We hope you have found these tips and recommendation helpful to help you with getting your baby to latch-on and breastfeed successfully.