Flat Nipples

[fionas]

OK, am starting to plan for baby no.2 after having a near-nightmare experience with BF my DD (now 3 months old). I am now FF DD so this is not about trying to re-establish BF with her. It was a long and guilt-ridden path to FF after two months of expressing and I am happy with the decision I made but would like to gather as much info as possible for next time.



I was told with DD that I had flat nipples and that's what was one of the reasons it was difficult to BF. Apart from using a manual pump to make my nipples more perky, is there anything in particular I should do next time? Do babies just get used to their mum having flat nipples and suck harder etc.?

[paradise lost]

My nipples were flat fionas and i did find the first few seconds of a feed would be sore, as she sucked my nipple out longer. I could really feel the ligaments stretching in there! After a few days i used to stretch them out by hand myself before i attached her, really pulling them out long (slowly so it didn't hurt!) then popping her on quick. It was still a little sore and they are now (after 7 months BFing) less flat than they were before BFing, but still pretty flat. Another thing i found helpful is to express off the beginning of a feed if i was very full (first thing in the morning whn she was sleeping longer for instance) as when the breast is very full and firm it's even harder for the nipple to stretch out, and the pump worked dual-action to stretch the nipple out and soften the breast a bit by taking some milk out. I think the main thing is to know that as the baby gets bigger it DOES get easier - the wider they can open their mouths the easier it is for them to get a good mouthful, no matter how flat one's nipples are. There is also a device (nipplette?) one can buy which goes on the nipple and works by suction to draw it out. Some women use them in pregnancy to help stretch their nipples a bit. Worth a look maybe?

I'm in the same boat really - had to wean sooner than i wanted, building a wall of knowledge as defence against the same problems next time.

Bx

[Barb Glare]

HI,
It sounds like you have had a really, really rough time. I hope things are looking up for you now.
In my experience, flat nipples are just great. To you baby they are just "her" nipples. She just get's on with the business of feeding on them. That has not happened in your case. I am betting that there are a whole lot of reasons around why breastfeeding didn't work out for you this time.
You will have some time between now and your next baby to reflect about what happened, and make some sense of it all. You will have time to read and educate yourself. (At a minimum you must see Sue Cox's "Mom and Baby I can do that" DVD - I'm sure you will find yourself nodding all the way through it) You will have time to do a breastfeeding preparation class. And your baby will be your best teacher of all - enjoy her until her brother or sister comes along.
Consider joining an Australian Breastfeeding Association group - there will be one near you. Groups are for all mothers - regardless of how you feed your baby. And you will find support and understanding of your role as a mother, and your mothering experiences. It's also a great way of making new friends and of building a network.
Comments like "you have flat nipples" can stay with you for ages. I have had women sit before me and say "I was told that breastfeeding didn't work be/c my nipples are flat" and they've been *fine*. It has me very confused. Sometimes I think it's just a short-hand way of health professionals deflecting their disappointment that they didn't have the skills to help you anymore
Warm Regards
Barb

[fionas]

Thanks guys. Hoobley, the nipplette thingybobby sounds interesting. Shall look into it closer to the time.

Barb, yes it was a bit of a rough ride and I heard just about everything in the hospital from flat nipples /jaundiced baby/lazy eater/only wants enough to take the edge of her hunger. I guess my nipples do look flat to me so that seems credible.

One more question if I may, what's the deal with getting back to birth weight? The hospital freaked because she had lost 12% by Day 3 and given the dramas we were having with BF, they threatened not to discharge me unless I gave her a bottle. I know that babies often take two weeks to get back to their birth weight and that is considered quite normal. It took my DD three weeks (and that was with FF). If the same happens again, what would you recommend? How long would it be reasonable to hold out for if I wanted to keep going with BF without being paranoid that I was harming my baby?

[MantaRay]

Fiona, Hugs to you hun. You've had a really hard time. My first son was born with a tongue-tie but I was told that my flat nipples were the reason he couldn't attach. It turns out that while I did have flattish nipples, the tongue-tie was the real problem and once that was fixed he could attach fine. Then when DS2 was born I was told by the mw that I had great nipples for bfing! Go figure!! So I think that if bfing your next baby is what you want then go for it. As Barb said join the ABA so you have some support around you. If the attachment is difficult again, you could always try nipple shields for a while. But you could also find that the nipples are better this time. Best of luck with it.

[RhiChiChi]

Great question Fiona, one that has been on my mind for a while, as I had a lot of difficulty bf due to very flat, almost inverted nipples, which lead to many things including blocked ducts, mastitis and in the end ff my DD. I too felt the same way you did, guilty etc.... so I can relate to you wanting next time to be well prepared for a better bf experience.
I just wanted to say, good luck for next time, I hope you have a better experience. I'd like to know how you go as this is something close to my heart....

[fionas]

Thanks MantaRay! I heard just about everything with DD from she may have a touch of jaundice (paed ruled out), to she's a lazy eater, to she only wants enough to take the edge off her hunger that's why she won't stay on to finally the flat nipple thing. I did use a nipple shield with her and that was OK but on being discharged from hospital, the 'regime' they had us on (nipple shield, formula then express) took 2.5 hours and I was meant to feed her every 3-4 hours because she wasn't back to birth weight. So that was a bit impossible once DP went back to work plus I could barely move because I've had a dodgy pelvis since Week 28. Oh woe is me!

But having now gotten to know her better I would say it was a combination of things. She seems to go from not particularly interested in food to VERY hungry in two seconds flat. I think her impatience combined with a bit of trickiness with flat nipples just frustrated the heck out of her. And when she is feeding, she enjoys a good old look around which she couldn't do on the boob. So I think it was a combo.

Like I say, I am very happy (now) with my decision to go to FF with her but forewarned is forearmed for next time and from my limited dealings with ABA, I think they're fantastic!

[Epacris]

to you Fiona.

I have inverted nipples and some of the midwives in the hospital would pinch them to try and make them come out a bit and I HATED it! It really took me by surprise because I can’t even remember them telling me what they were going to do, let alone asking me if it was ok. But I was too overwhelmed at the time to say NO STOP TOUCHING MY NIPPLES!!! It wasn’t all of the MWs, jut a couple of them and by day 2 I was strong enough to tell them to bugger off if it looked like they were about to give them a tweak. In my experience it was completely unnecessary for anyone to touch my nipples. If you feel comfortable touching them then that’s fine but don’t feel like you have to let other people touch them. And I never did, I just put DS on and he pulled them out himself (but I think he was a good sucker) and I found his sucking much gentler than nasty fingers.

I read lots about BFing while I was pregnant because I was worried that I wouldn’t be able to do it. In the early days I paid very close attention to getting attachment right. I would attach DS myself and get a MW or LC to check. I did this for every feed for the first few days (I was in a Private Hospital and so had MVs whenever I wanted for 4 days). What worked best for me was to just shove as much of the areola in as I possibly could. Sometimes I would poke a bit more in on the side with my finger, rather then pull off and reattach and surprisingly that seemed to work a treat for us. I never used a nipple shield.

The MWs and LCs kept going on and on about it not hurting if you’re doing it properly. They kept saying that if it hurts, then your attachment’s not correct. For me it really, really, really hurt and all the MWs and LC agreed that the attachment was right. Then at about the 6 week mark it suddenly just stopped hurting and we’ve been going strong ever since (I’m still BFing now).

I hope my story helps. Goodluck.

[rurumummy]

Hi,

I had the same problem while trying to bf dd1 and ended up ff,but with dd2 i bought that NIPPLETTE device and i have gotta say it is fantastic!!
I did use a nipple sheild for about 1wk but then i was able to take it off and she would attach on her own.
I have very very flat nipples almost inverted...well i should say Had because the nipplette actually has made them non flat and i dont think i will need my nipplette to bf the next bubs.
If your intersted in the nipplette the company avent make them.
Good luck!!

[AnyDream]

Fiona, I have flat nipples and successfully BF DD1 for 18 mths, and am now feeding DD2 happily as well. I would agree the first weeks were very difficult (both times). First time round I was in a BFing not-very-friendly hospital and it was a *nightmare* - however I was lucky to have met a lactation consultant (not on the staff) who spent time with me on day 2 and 3 and saved my lactation. This second time, I was in a large hospital with the breastfeeding accreditation - completely different experience. I still ran into problems after the first 24 hours but had skilled staff who had the time to help me when I needed it. It meant chosing a public over a private hospital but well worth it IMO. So maybe as part of your preparation, consider where you are planning to have your baby so that you have skilled LCs on hand when you need them.

I also agree with Rachel's story about it still hurting like nothing else even tho the attachment was correct...and then suddenly after a few weeks the pain stops and you realise you're not gritting your teeth every time!

BTW, I just want to express my admiration for you for expressing as long as you did as it sounds like you had a really tough time!

[Soph]

Fiona - I could have written your story about your DD myself. It was exactly the same with my DD. I expressed for 8 weeks, have v flat nipples, she was v jaundiced.....it goes on.....

Anyway I am still BF DS and he is 13.5 months old. It can be done! I just made sure I was really prepared this time. I joined the ABA, hooked up a LC while I was still pg, had nipple shields on standy if I needed them, and read up on everything I could. When I had DS every feed I would buzz for someone to come and check attachment. I kept saying 'Yes this is my second child, but I couldn't BF my DD and I really want to BF this time.' You really have to keep saying it because I think that when you are a second time mum, a lot of the time they think you know it all already - not true! I said I didn't want to leave hospital until he was BF (yeah it was public but a FANTASTIC hospital - heaps better than the private one I had dd in). Just keep at it and make sure you have some support to help with DD when the baby comes so you can focus on feeding in the first few weeks too.

Good luck. It can happen. I never thought I'd be feeding still and now he won't wean LOL!

[Barb Glare]

Hi,

The "deal" with birthweight is that you would normally expect that a baby born in a hospital environment would lose up to 10% of their birthweight and then regain it by 2 weeks. These are guidelines - to be observed and acted upon. There's not necessarily anything "wrong", but efforts do need to be made to find out what is happening with that mother and baby. Often times it is hospital routines that contribute to this. It is fairly well know that when mothers have a homebirth, co-sleep with their babies and have baby skin to skin, babies may not lose any weight. So, for instance, if a baby has lost 12% you might consider whether baby had been carrying fluid from an IV, you might observe that baby had show effects of drugs mother had been given during labour, and you might want to offer more support to the mother with breastfeeding. If you could observe that breastfeeding was going well, milk coming in, babies stools were changing from meconium to yellow, you would just continue to keep an eye on the situation. Some-how hospital staff do often manage to impart a sense of panic to mothers. Likewise with regaining weght by 2 weeks. If baby had lost a greater than normal amount of weight, then it would take longer to get back to birthweight. It is often noted that mothers who have had caesarian birth take longer for babies to get back to their birthweight. Mothers and babies are more likely to be separated, babies may suffer the effects of drugs, and it's just darn hard to position a baby when you are hooked up to machines and monitors! One thing tends to cascade into another.
Recover from this birth, get to know your little one, as you are doing. Your next breastfeeding experience will be soooo much easier.
Regards
Barb

[paradise lost]

It is fairly well know that when mothers have a homebirth, co-sleep with their babies and have baby skin to skin, babies may not lose any weight.

That's exactly what happened to me and DD Barb. She was 7lbs 14.5oz at birth and 8lbs 6oz on day 5, 9lbs 1oz on day 10 (!). We never looked back. I'll need a *powerful* reason to birth any future babies in hospital.

Bx

[Liviam]

Hi Fiona. I have one flat nipple and one inverted nipple and after an absolutely nightmare start (even with a heap of help and support) I was throwing in the towel when my LC introduced a nipple shield and we haven't looked back. In fact, as Olivia has gotten older and a much better feeder we have weaned off the shield of one side and are cruising along. Please don't be afraid to use nipple shields (only after your milk has come in) because they really can be a help and you can wean off the shield as your baby gets older.
Best of luck with preparing for #2. I know I'm going into this armed with information and a lot more prepared. Hopefully all your prep work will give you the most wonderful b/f experience.

[fionas]

HI guys

Thanks for all your support and advice. I will definitely get the ABA videos.

Rachel, I hear what you're saying. Last time the (private) hospital's efforts to support me ended up completely peeing me off and I'm a bit paranoid about asking for help (apart from in a virtual environment like BB) ever again. There was lots of conflicting advice, lots of holding babies head and my boob and shoving both together, and virtually forcing me to keep going every breastfeed for over an hour each time. Not pleasant. It really wasn't the pain that worried me at all, after the pain of labour I had my pain management techniques down pat by that stage; it was the invasiveness of the help and the fact that I would get a different midwife each time who would tell me something different from the ten previous midwives. Anyhow, I was always told that she and I were attaching fine but the mystery was why she wouldn't stay on. Then when I was given a nipple shield by the hospital's lactation consultant, another LC that I talked to over the phone basically told me no, no, no don't use it, it's the devil's work.

Julia, I hope the tips that people have given will help you too. Good luck to both of us for next time!

Hoobley - way to go on that weight gain. A homebirth is not for me but I very much see why it is a very good choice for lots of women and good on those that do.

It is very difficult when you are faced with a situation where your baby has lost a lot of weight on the one hand so you're being advised to give formula but also told on the other hand that giving formula will affect whether you will be able to breastfeed.

Barb - thanks for that info on weight loss/gain. It is all useful background.

Roll on the next one!

[RhiChiChi]

Sorry to hijack the thread Fiona, but how long do you use the NIPLETTE during pg?

[fionas]

Hijack away Julia - I should have thought to ask that!

[Epacris]

Yeah, yeah, yeah Fiona, I hear you on the conflicting advice. I was told so many different things and every MW thought their advice was the best/right advice. It is just so confusing and hard for a first time Mum to make sense of it all.

Anyway, I’m sure you’ve worked this out for yourself but I’ll just tell you too: don’t hesitate to ask for help and advice if you need it and in the same breath, don’t hesitate to disregard it if it doesn’t work for you.

And I also just want to say:

Wooo Hooo! Women of the world with flat/inverted nipples unite! More power to us!