Breastfeeding with flat nipples
Breastfeeding with flat or inverted nipples
Nipples come in all shapes and sizes. Even between breasts belonging to the same person, there can be variations!
The majority of nipples will protrude enough to allow latching to be reasonably comfortable.
Sometimes, however, there are some shapes and sizes that can create more of a challenge for your baby.
For your baby to latch at the breast well, your nipple acts as a stimulus.
When your nipple brushes past your baby, just under his nose, this 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 go into your baby’s mouth.
The nipple stretches a little, forward, and upward against the roof of your baby’s mouth.
You can imagine, if your nipple is flat or inverted, this may be a more significant challenge.
The good news, however, 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’s imperative, 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, so make your breastfeeding position as comfortable as possible.
Please note that if you have a truly inverted or flat nipple, then it isn’t likely to protrude on stimulation either with a pinch test or with cold.
It’s also possible to have a flat or inverted nipple on one breast and a nipple that protrudes more on the other breast.
Breasts work independently regarding milk production, and they are also likely not to be completely symmetrical!
You may have a nipple that protrudes only on stimulation or an inverted nipple that goes even further inside on stimulation.
There is such a variety of possibilities!
If you are pregnant 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.
There is certainly quite a lot of disagreement amongst experts about this, but the general advice appears to be that it’s better to leave things alone, and see how the baby latches after the birth, and to take it from there.
So what if you have already started breastfeeding and your newborn is struggling to latch at the breast?
There are several things that you can do.
First of all, I would suggest that you use a good quality breast pump to help keep up your supply while you’re working on this attachment issue.
This will ensure that your body makes all the milk that your baby needs, and secondly, the 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, and 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 with your thumb and index finger, you can roll it just for a minute or two and afterward quickly touch it with a moist cold cloth.
This method can help your nipple to become erect.
To help your baby to latch
As your hand supports your breast for the latch on, with your thumb on top and four fingers underneath and behind the areola, you can pull slightly back on the breast tissue towards the chest wall – this will help the nipple to protrude before latching.
It’s also crucial that you ensure good comfortable feeding as good positions will aid attachment and aid a deeper latch as well.
A lot of laid back biological positions enable babies to latch more deeply.
Try to feed as frequently as you can, keeping your breasts as soft as possible because if you get engorged, where your breasts have become overly full to the point of pain, the engorgement can make it even more difficult for your baby to latch.
Once again, there is added information around engorgement and how to deal with this.
I would also encourage you to learn the technique of breast compression because this technique will help your baby get more milk at the breast when he does latch.
Babies who are having difficulties with latching, often get frustrated at the breast and not actively swallow, especially if they usually have milk via a bottle.
Sometimes this extra help to access milk will help greatly.
In the early weeks, it can certainly take a bit of time and practice to get used to latching, and nipple soreness is a common issue at the beginning for many breastfeeding mothers.
There can be further challenges for women who have flat or inverted nipples. You may wish to consider the use of 100% lanolin to ease sore nipples.
Pat your nipples dry after latching and apply, to alleviate discomfort and promote healing.
If you are still quite sore even after a week or two, maybe longer, and you continue to have latching difficulties, a hospital-grade double pump is an excellent tool to maintain your milk supply.
Some women decide to stop feeding at the breast for a time and exclusively pump their milk just until their nipples start to protrude better with the regular pumping.
Remember, your breasts work independently, so if, for instance, your baby is latching better on one side than the other, or not at all on the other side, the pump can keep your supply up on the more difficult side until things improve.
You can use the pump to keep up your supply and also to help to draw out your nipple.
For some women, it may only take days to draw out the nipple (it may even happen from the first pumping session), but it could also take weeks or months. It varies from person to person.
Once your baby can feed effectively without the pump, then it can be discontinued, but usually, this is a gradual thing.
Even if your baby is feeding at the breast effectively, you may find that your nipple will invert again intermittently, so you may still need to use your pump at times.
Remind yourself that your baby is growing fast and his mouth shape and size changes over time.
Things almost always improve, and with a second or third baby, those inverted or flat nipples may look very different, because of all your previous pumping and feeding.
Review dates, references & further resources
Version 1.1 published in March 2019. Next review date: Jan 2022
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