Breastfeeding with flat or inverted nipples

Before your baby is born:
What are flat or inverted nipples?
How to tell if your nipples are flat or inverted.
How to prepare for breastfeeding with flat or inverted nipples.

After your baby is born:
How to breastfeed with flat or inverted nipples.

What are flat or inverted nipples, and how can you tell if you have them? (back to the top)

• Most women have nipples that stand out from the areola. Some, however, have nipples that don't stand out, or even go in. These are flat or inverted nipples.
• Even if you have flat or inverted nipples, you might have no trouble breastfeeding. There is a simple test you can use to check this.

• Do not perform this test before the third trimester (6 months to the end) of pregnancy. Up to 35% of women may have flat or inverted nipples before pregnancy. But great breast changes take place during pregnancy in preparation for breastfeeding. Your breasts enlarge as they develop milk glands. Your areola darkens and enlarges; some people think this darkened areola serves as a visual target for the nursing baby. Your flat or inverted nipples may start protruding. If they do, you'll have nothing to worry about.
• During your third trimester, check your nipples. If you have nipples that are flat or inverted, do the following:
  • See if they remain flat or inverted when stimulated. Put some cool water on them (not ice; you don't need to torture yourself!). Tickle them a little bit. If you happen to have a breastpump around, pump for a few seconds. If you don't have a breastpump, you can ask your mate to help. If your nipples protrude as a result of this and remain protruded for some time, then you'll have nothing to worry about.
  • Put your thumb and finger on the areola just a little behind the nipple. Squeeze gently. If this causes your nipple to protrude, you have nothing to worry about.
  • If your nipple remains flat or becomes even more inverted when you squeeze the areola, then you should start preparing them for breastfeeding.

• Start these exercises during the third trimester of pregnancy.
• Wear breast shells. Follow the manufacturer's recommendations.
  • You might need to wear a larger bra to accommodate the nipple shield. If so, buy a couple of nursing bras. Your breasts will enlarge even further during the early stages of breastfeeding, so you'll probably need those larger bras anyway.
• There are also some other exercises that you can do. Stop doing them, however, if they hurt or discomfort you. You don't want to damage the sensitive breast tissue.
  • Gently pull and roll your nipple between your thumb and finger. You can do this for several minutes a day. If it hurts or is uncomfortable, don't do it!
  • Put your thumb and finger on the areola behind the nipple. Push slightly in towards your ribcage. Slowly slide your thumb and finger out to the edge of the areola. You can do this for several minutes a day. If it hurts or is uncomfortable, don't do it!

• Latching on might be more difficult than with protruding nipples. Usually, however, there is no real problem.
• You should be especially strict about avoiding bottles and pacifiers if you have flat or inverted nipples. Bottles and pacifiers can cause nipple confusion in any baby. The risk is especially high if you have flat or inverted nipples.
• See if your baby manages to latch on correctly. If your baby is showing signs of feeding well, and you don't experience sore nipples or persistent breast engorgement, everything is fine.
• If your baby is having difficulty latching on, or you have sore nipples, then you might need to prime your nipples before nursing each time:
  • You can wear your breast shells for a few minutes before nursing, and remove them just before attaching your baby.
  • You can pump with a breastpump for a few seconds just before nursing your baby. Stop just as the milk starts to come out.
  • You can use your nipple tickling and rolling exercises for a few seconds before nursing.
  • All these exercises help the baby latch on by making the nipple stand out.
• IMPORTANT: do not use nipple shields while nursing your baby. Some older books may recommend these. However, they are best avoided as they cause the baby to latch on incorrectly. This may lead to sore (or even cracked and bleeding) nipples, severe breast engorgement or mastitis in the short run and insufficient milk in the long run. Don't use them!
• If you seem to have serious or persistent problem, call a certified lactation consultant. It costs a little money, but it's definitely worth it. Just one visit from a lactation consultant can make the difference between a miserable and a delightful breastfeeding experience.
• If your baby is not latching on properly, watch out for insufficient weight gain. This need not stop you from breastfeeding if you take a few precautions while you tide over the difficult period. See the page on maintaining or increasing your milk supply for more information on this.

• Breastfeeding problems and solutions

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