Women come in all shapes and sizes. This extends to her breasts, and even her nipples, too.
No two women have exactly the same breastfeeding anatomy, and no two babies suckle in the same exact way. When all goes well, baby's mouth is perfectly matched to mother's anatomy. Flat or inverted nipples can be a game-changer, though. Keep in mind while one mother baby pair may have difficulties if a mother's nipples are flat, another couple may breastfeed without difficulty.
The good news is that babies BREASTfeed, not NIPPLEfeed. So no matter what type of nipples you have, it's likely that you're going to be able to breastfeed your baby ” though some mothers and babies may have more learning to do than others.
Get To Know Your Breasts Before The Birth
They've been attached to your body all your life, but how well do you really know your breasts? If you are doing monthly breast self-exams, you will know what your pre-pregnant breasts felt like, and what changes have happened since conception. Your breasts likely grew in size, and feel heavier. You may see more veins, small bumps called Montgomery's glands, and a darkened areola. You may even leak colostrum in the later months of pregnancy.
One thing you can do when you examine your breasts is determine what type of nipples you have. Do your nipples typically stand out when you're cold, or when they're stimulated? If they do, you don't have flat or inverted nipples. If you're not sure, try a ‘pinch test.' To do this, compress the areola about an inch away from the nipple, and observe what happens. If your nipple remains flat or if it appears to pull in, then you know you have flat or inverted nipples, and you can come up with a plan for how to approach feeding before the baby is even born.
Sometimes Women Have Temporarily Flat Nipples
Sometimes flat nipples are caused by too much IV fluid during the labour and birth. While this should resolve as your body reabsorbs and excretes all of the extra fluid, it can cause challenges latching your baby in the early hours and days, just when you're both trying to learn to breastfeed. Work with someone knowledgeable about breastfeeding ” someone who can observe the baby at the breast, and help you find the best way to get baby latched. Reverse pressure softening (see here for additional information) is an excellent way to help baby latch to a breast with flat nipples, as is spending time skin-to-skin.
Some women in this situation are offered a nipple shield ” a silicone nipple that fits over your own and offers baby something hard to latch onto. Resist the temptation. It's better to work at getting baby onto the breast. Keep in mind that babies don't need much at first ” if your baby won't latch, try hand expressing colostrum onto a spoon every couple of hours and feeding this to baby (just let baby lap it off the spoon, or slowly dribble it into baby's mouth).
For some women, engorgement when their milk comes in (2-5 days after birth) leads to a flattening of the nipples making it difficult for baby to latch. Part of the swelling is caused by a sudden increase in milk, but part is also caused by an increase in other fluids, which your body reabsorbs. This engorgement shouldn't last more than a few days. Be sure you are nursing often so that your beasts don't get overly full, and watch for signs that your baby is transferring milk well. To get your baby to latch, reverse pressure softening, along with techniques where you shape the breast (see below), work best in this situation.
For women with large breasts, it may be the weight of the milk behind the nipple and areola being pulled forward by gravity that causes the flattening. Laid back positioning helps in these cases.
If You Have Truly Flat Or Inverted Nipples
Flat nipples tend to be problematic when latching, but once baby is latched, the nipple stretches normally and the baby can feed well. Inverted nipples are a little more complicated. Sometimes, baby's suck pulls the nipple out without difficulty. If the baby has a weak suck, he may not be able to do this, though. Or if there are adhesions that keep the nipple from stretching very far, it limits the amount of milk baby is able to get.
No matter what type of nipples you have, the first step is to get baby latched. Some ideas to accomplish this with flat or inverted nipples include:
#1: Draw The Nipple Out Before Feeding
You can try manually expressing milk for a short while before feeding or you might use a breast pump to get the nipple to stand out. A couple of companies sell a syringe-like device especially for everting the nipple before feeding.
#2: Shaping The Breast
Make a ‘breast sandwich' by placing your fingers an inch or so from the nipple, then compress the areola to flatten the breast (like you would if you were eating a large sandwich). This creates something firm for baby to latch onto. Or try something called the ‘nipple nudge' ” use the index finger of the hand that's supporting your breast to push up and out from behind the nipple (making it more prominent).
#3: Wearing Breast Shells Between Feedings
These devices are hard plastic domes worn over your nipple and inside your bra that put pressure on your areola to help the nipple stand out and to possibly stretch any adhesions that may be holding the nipple back. An added benefit is that if your nipples are sore (which is fairly common with inverted nipples), your clothes won't rub against them and cause added discomfort.
If none of these tricks seem to work, a nipple shield might be a good solution. A nipple shield gives baby something solid to latch onto ” which can be one of the major hurdles with flat or inverted nipples. If all else fails, some moms with flat or inverted nipples decide that pumping and bottle-feeding works for them.
If you have inverted nipples, you should keep close track of your baby's wet and dirty diapers, as well as his weight gain, to be sure he is getting enough milk. For some babies who cannot get enough milk at the breast with the nipple inversion, supplementation may be necessary. A knowledgeable breastfeeding professional should be able to help you with positioning and latching your baby for successful breastfeeding, as well as helping you know if your baby is getting enough.