Breastfeeding with flat or inverted nipples

Breastfeeding with flat or inverted nipples - Transcript

It’s certainly very true that nipples come in all shapes and sizes, and even from breast to breast there can be variations. The majority of nipples will protrude enough to allow latching to be fairly easy but sometimes there are some shapes and sizes that can make it a little bit more difficult for your baby to latch.

So in order for your baby to latch at the breast well, your nipple acts as a stimulus – when your nipple brushes past your baby, just under the nose area, that provides the stimulus that causes a big wide mouth to happen. Your baby’s tongue then comes out and scoops up breast tissue, and that tissue, including the nipple, will then go into your baby’s mouth. The nipple then does need to be stretched a little, forward and upward against the roof of your baby’s mouth.

You can imagine, if your nipple is flat or inverted, this might cause a little difficulty. The good news is that babies breastfeed, not nipple feed, so if your baby can take a good portion of breast tissue into his mouth, then breastfeeding can carry on fine.

So it is really important, as it is for all babies and mothers in the early days and weeks, to get off to a good start with positioning and attachment. Please look at the videos about comfortable breastfeeding because all of those things are important.

If you have a truly inverted nipple or flat nipple, then it isn’t likely to protrude on stimulation either with a pinch test or with cold – it’s also very true that it can be possible to have a flat or inverted nipple on one side, and then a nipple that protrudes more on another side.

Breasts certainly do work independently, and they also appear differently as well (from an anatomical point of view). You may have a nipple that protrudes only on stimulation, or it could be you have an inverted nipple that goes even further inside on stimulation. There is such a variety of possibilities.

So if you are pregnant at the moment and you have flat or inverted nipples, you may be wondering whether there’s anything you can do to prepare in advance of the birth, but certainly quite a lot of disagreement amongst experts about this, and the rule of thumb appears to be that it’s better to leave things and to see how things go after the birth, and to work from there.

So if you have already started breastfeeding and your newborn is struggling to latch at the breast, then there are a number of things that you can do. First of all I would suggest that you use a good quality breast pump to help to keep up your supply, while you’re working on this attachment issue, (and that will mean that your body will make all the milk that your baby needs), and secondly, that pump will also help to draw out your nipples.

Your baby will get better at doing what he has to do to get a good latch on the breast, even with flat or inverted nipples. The breast pump will help to keep your supply up while your baby is doing this.

So how can you tell if your nipples are flat or inverted? You can do what they call a pinch test. You gently compress your areola (which is that dark area around the nipple), about an inch behind your nipple. If your nipple does not become erect then it’s considered to be flat. If the nipple goes inside, retracts, or becomes concave, it’s considered to be inverted.

We do know that true inverted or flat nipples will not become erect when stimulated or exposed to cold. If the nipple becomes erect during the pinch test it is not truly inverted. Also if the nipple can be grasped you can roll your nipple between the thumb and index finger, just for a minute or two, and then afterwards quickly touch it with a moist called cloth. This method can help your nipple to become erect.

So as you hand supports your breast for latch on, with thumb on top four fingers underneath and behind the areola, you can pull slightly back on the breast tissue towards the chest wall, to help the nipple to protrude. This can help your baby to latch.

Of course, as I did mention earlier, it’s really important that you get to grips with good comfortable feeding, good positions that will aid attachment and aid a deeper latch as well. Certainly, a lot of laid back biological positions have been found to really enable babies to latch in a deeper way. Try to feed as frequently as you can, keeping your breasts as soft as possible, because certainly if you get a little bit engorged (where there’s a general congestion going on), maybe there’s been a slightly longer gap between the feeds, then your nipple and areola area, even if they’re already a little flat, or completely flat, then the engorgement can make that even more difficult for your baby to latch. Once again there is added information around engorgement and in the prevention of that.

I would also encourage you to learn the technique of breast compression too, (see video) because sometimes when babies are learning to latch, and especially in these kinds of situations with flat and inverted nipples, and some added difficulties here, then you need to keep everything as calm and comfortable as possible and keep your baby as calm as possible as well. Sometimes babies need a little bit of extra help to access milk as well when they are finally latched – so breast compressions are a great tool for that.

In the early weeks, like many mothers and babies, it can certainly take a little bit of time to get used to latching and nipples soreness is a very common issue at the beginning, but it can be more so for women who are flat or inverted nipples. In that situation pat your nipples dry after latching, and apply some 100% lanolin. This can certainly help to ease discomfort.

If you are still feeling that even after a week or two, maybe longer, you’re still feeling quite sore, and latching is hit and miss at times, the hospital grade double pumps are excellent tools to keep your supply up. Some women have used them and stopped latching for a while just until the nipples start to protrude better with the regular pumping.

Your breasts work independently, so if for instance, your baby is able to latch much better on one side than the other, or not at all on the other side, the pump can keep your supply up on that poor side until things improve. So if you are using a pump to keep up your supply and to help to draw out your nipple, it certainly can be very variable from woman to woman how long it may take for the pump to keep your nipple out. For some it may be days – and might even be from the first pumping, but it might be weeks and it could be months as well. So it really does vary from person to person.

So once you baby can feed effectively without the pump then it can be discontinued, but usually that would be a gradual thing. Even if your baby is feeding at the breast absolutely fine, intermittently you may find that your nipple will invert again, so you may still need to use your pump at times. Remind yourself that your baby is growing really really fast and mouth shape and size changes over time. Things definitely improve, and with a second or third baby often those inverted or flat nipples can look really different and be different the second or third time round, because of all the hard work that went in previously.

Review dates, references & further resources

Review Dates

V1 published June 2017. Next review date: April 2020

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