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Inverted Nipples and Breastfeeding: What You Can Expect

The only "intuitive" interface is the nipple. After that, it's all learned.”

This is a very cute and famous quote. I agree that human babies (or a baby of any mammal for that matter) has an intuition which lets them suckle the nipple within minutes or hours of their birth. But sometimes babies need to be trained to feed on breasts.

And yes, human nipples are not a standard commodity and are usually capricious. You might not have thought about them so deeply, but as you get ready to breastfeed your little one, we want you to know a couple of things about those tiny milk feeders!

8 Nipples Come in Different Shapes and Sizes

As nature wanted it, nipples come in different shapes and sizes. Ideally, the nipples are meant to be protruding from the breast which helps the baby get a grip on them and helps him nurse with ease. But sometimes the nipples do not stick out as expected and might cause problems with breastfeeding (generally it is not a big deal, though!)

But some women have flat or inverted nipples. Flat nipples as the word suggests, are flat (instead of popping out). Under normal conditions, they are almost at the same level as the areola and sometimes do not stand out even if stimulated.

Some women, on the other hand, have inverted nipples. The nipple retracts or pulls inwards even when stimulated. Commonly, they may seem to be flat or slightly concave while in some rare cases they are completely divot and dented.

You can either determine yourself, or a quick examination by your doctor helps you determine if you have a flat or inverted nipple. Do it yourself method is also called the “pinch test”. Simply squeeze (very gently yet firmly) the area around the nipple (areola) using your index finger and thumb about an inch behind the nipples.

If the nipple doesn’t pop out or rather pulls inward in a concave manner, then you can say that the nipples are inverted. And if they protrude then they are not really inverted and are not likely to cause much trouble to the nursing baby.

7 What to Expect When Nipples Are Not Normal

So what causes nipple inversion? It’s due to the close binding between the skin of the nipple and the underlying tissue due to the adhesion at the base of the nipple.

Many women have flat or inverted nipples during their first pregnancy. Sometimes the nipples just don’t pop out as expected, but as the pregnancy progresses the skin becomes loose and stretchy. And the problem is almost resolved with the delivery.

As per records hardly 10% of the women have inverted nipples during the birth of their baby. It is found that with each subsequent childbirth, the skin becomes more elastic and the inversion gradually decreases.

Some babies nurse vigorously and help tear this adhesion at the base of the nipple and thereby help the nipple to protrude in due course of time. On the other hand, many mothers with flat or inverted nipples experience some degree of nipple soreness due to breastfeeding.

As the adhesion breaks when the baby suckles vigorously, you experience soreness due to the crack in the nipples, which might aggravate with continuous nursing and the moisture in the nipple makes it worse. It’s advised to always keep the nipples dry after each feed to avoid any soreness or pain.

6 How to Deal with Breastfeeding

Soon after the baby is born you will want to breastfeed him. And most practitioners believe that there is nothing much to do before the delivery as the breasts and the nipples know how to rise up to the occasion and do their job. But the level of difficulty in feeding will depend on the degree of inversion in the nipples and a lot depends on the nursing baby as well. If your little one is a real fighter who is healthy and strong, he will energetically nurse and might be able to comfortably pull out the nipples.

But there are some extreme cases where the nipples don’t pull out even after stimulation and in fact, they retract more when the breast is engorged with milk. Sometimes they even hinder the milk supply. This might create some serious implications as the baby doesn’t get its feed properly and the milk production also reduces considerably.

Before we tell you how to deal with such situation, you should go ahead and try breastfeeding your baby normally. That is the best way to see if the baby is able to latch on and grasp the breasts for the feed all by himself. If the baby is unable to nurse by himself you can try softening the areola a bit with your gentle hands and maybe express a little milk from those overly full breast; so that the baby can latch on them with a better grip.

5 Alternate Ways to Feed the Baby

In spite of all the efforts from the baby, if he’s still unable to nurse, then you may have to consider some external methods. For example, the mother can try using a breast pump to pull out her nipples or maybe apply a cold press to stimulate the nipples. You may have to do this each time before the baby feeds.

Generally, while one breast has an inverted nipple, the other might be fine and can feed the baby normally. You may feed the baby exclusively on the normal breast first while you stimulate the other breast with the inverted nipple and soften the breast for better grip. You can also express the milk using the pump from the inverted nipple and happily feed the baby with the satisfaction that it is your own breast milk after all!

Another method is to use a nipple shield. Shields are silicone nipples with holes which are very thin yet flexible. They fit perfectly over your nipples and help the baby get a grip on the breasts and nurse. A shield is a very helpful device because it can play an important role is helping mothers continue breastfeeding for their babies. A shield must be used under the prescription and supervision of lactation consultant.

4 Exercises to Prevent/Correct Nipple Inversion

One common exercise used to make the nipples protrude is Hoffman technique. In this method, you place the thumbs of both the hands at the base of the nipple and gently but firmly pull both the thumbs in the opposite direction (away from each other). It is recommended to start this practice by doing this two times a day and slowly increase it to 5 times daily. This can be done throughout the pregnancy and even during breastfeeding in order to pull out the inverted nipples.

Another method is stimulation of nipples. This can be done by using your thumb and index finger to gently roll the nipples between the fingers. Do this for a few seconds and they will be erect and will pop out. You can take the help of your partner for this. He can stimulate the nipples during lovemaking, which he will enjoy as well!

A cold compress also helps to stimulate your nipples. You can use the cold compress just before nursing the baby. A moist nursing pad just out of the freezer will also serve the purpose of erecting the nipples. This helps the baby get an erect nipple to latch on and helps him nurse with ease.

3 Precautions While Using Shields

Though the plastic devices called shields are a great boon to the mothers with inverted nipples there are many ill effects of using a shield. Lactation specialists don’t generally recommend their use, it’s better to avoid any artificial nipples during the initial stages of breastfeeding as it can cause nipples confusion.

Earlier the shields were made of thick rubber which prevented the physical contact of the baby with the mother’s breast. Body contact is a much-needed phenomenon to maintain a continuous supply of milk. Hence, the use of shields is attributed to the reduction in milk supply which is not acceptable. Though today’s silicone shields boast of being thin and lean, nothing can come close to the skin to skin touch of the baby and the mother in stimulating the milk production.

Shields are used mostly in the initial stages in order to make the baby latch on to the breast comfortably. The babies soon learn to nurse without the shields. But in some cases, the babies need to be weaned and this can be done slowly and steadily. It’s also recommended to constantly watch the weight of the baby when using a shield, to ensure there’s no reduction in the milk supply to the baby and he is properly nourished with the mother’s milk.

2 Encouragement to the Breastfeeding Mother

The most important factor during any complications in pregnancy is the mental state of the mother. The mother should be fully confident and ready to face the challenge and come out with flying colors. Even when there’s difficulty in nursing due to the inverted nipples, the mother needs to be encouraged to continue breastfeeding, so that the baby gets nourished in the best possible manner.

If the mother is stressed or overly anxious, the milk production gets affected adversely. With continuous breastfeeding, the baby also helps to pull out the nipples.

Apart from the mother, the baby also needs some encouragement and pacification as he is at the receiving end. There might be times when the baby doesn’t get enough milk due to the difficulty in latching. This might leave the baby hungry and irritated. He needs to be loved, comforted and reassured. You can give him some expressed milk or any alternate feed (like formula) so that he is not left hungry.

Breastfeeding has to be a positive activity for both the mum and the baby. The more she feels the baby on her breasts, the more she will be inspired to nurse him (without a shield). This will ensure a steady production of milk and he will soon get used to latching on her breasts for that life-giving fluid!

1 Conclusion

We all know that breastfeeding is very important for the baby and to a certain extent to the mother as well. With inverted or flat nipples, this process might be difficult; but with the above-mentioned techniques and alternate methods you can make sure the baby gets his share of nourishment from your breast milk.

Most women mainly first time mothers need some mentoring and help with breastfeeding especially if there are some complications like inverted nipples. A medical practitioner, a family member or a friend can be of great help to her, guiding and encouraging her through this beautiful journey of motherliness which is a lifetime of bliss!

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