What should you know about breastfeeding?
Before you start breastfeeding you need to know that it can be tough in the beginning. You may feel pain, nipple soreness and have a hard time getting your baby to latch on correctly. This is all normal for a couple of weeks when starting out with breastfeeding. But if this goes on for longer than a month or so, I suggest you speak with a lactation consultant immediately.
Something else to keep in mind is if something doesn't feel right or if your baby isn't latching correctly, don't try and fix it yourself - get help from someone trained in infant feeding. It's important to understand that latching issues could affect how well your baby feeds and drink which may lead to low milk supply (read more about low milk supply here ).
Some of the things lactation consultants look for when assessing a breastfeeding position are: how the baby is positioned, how your breasts are being stimulated and drained, nipple positioning in the baby's mouth, latch-on technique, and signs of proper swallowing. But there could be other problems that may need to be addressed immediately. What I'm going to talk about today deals with one of those problems - flat or inverted nipples.
Flat or inverted nipples?
"Inverted nipples" simply means that some women have nipples that won't protrude no matter what they do even though all the glands are healthy. Some babies will still try to breastfeed from them but it can be difficult if not impossible for them because their tongue cannot stimulate milk let-down. The baby usually will just suck without making any progress into the breast tissue.
"Flat nipples" means that there is no glandular tissue in the nipple itself - they are sunken in and can't be drawn out even by forceful expression (by hand or pump). Sometimes if a woman starts out with flat nipples, she may start to make some progress because it becomes easier as time goes on to express milk from them using various techniques.
Some women do not have any glandular tissue at all but still produce milk because there are other glands surrounding the nipple area (but these types of women cannot provide enough milk for their babies). If your lactation consultant/midwife/doctor detects that you don't have much glandular tissue in your nipples, they will recommend alternative positions for breastfeeding.
Problems associated with flat or inverted nipples :
- Inverted or flat nipples can affect a baby's ability to successfully attach and breastfeed.
- It may take longer for the milk to start flowing from the mom's breasts if there is little stimulation from breastfeeding. This could lead to a low milk supply over time.
- Breastfeeding difficulties - poor latch on, not latching at all because the baby cannot stimulate milk production, pain during feeding since nipple won't draw out easily even when the milk starts flowing, etc. The list goes on...
When you have flat or inverted nipples, it can be difficult to breastfeed depending on how much glandular tissue (if any) you have as well as how your little one latches on. In the first two to six weeks, you will likely be able to breastfeed even with flat/inverted nipples - if your baby is willing to take the trouble. But after that, chances are that something will have to be done about it or you will need other milk sources for your little one.
The good news: there is a simple technique that can help you draw out your nipple and it does not require any expensive procedures.
How to draw out inverted or flat nipples?
This method involves repeatedly pulling on the skin around the nipple so that the nipple itself is pulled outside of its hood. You can ask somebody else to do this or use a simple manual breast pump.
WHAT YOU NEED: a gentle manual breast pump (see photo below) or your own two hands
STEP 1: Positioning - Lie down on your back or lean forward with your head above the rest of the body so that gravity will help draw out the nipple. Make sure you are relaxed and comfortable before attempting to draw out your nipple.
STEP 2: Stimulate milk flow - Use a gentle manual pump with slow strokes or apply hand compression around the breast before latching the baby onto it. If using both methods, do them at different times i.e., the first pump then does step 3, then vice versa; use whichever method is easier for you. Baby can be latched on after this step but make sure that he/she has opened her mouth wide so that the whole areola is drawn into her mouth.
STEP 3: Stimulate milk flow - grip your nipple between thumb and forefinger (as shown in the picture above) and pull gently downwards towards your baby's chin. Repeat this step several times until you see your nipple beginning to protrude or try inserting a finger into your baby's mouth first to stimulate milk flow before latching on. The more you practice, the easier it will be for you to draw out your nipples even without these extra steps! Remember, don't give up even if it doesn't work after one attempt because sometimes it can take several weeks of daily practice to make any progress.
After practicing drawing out your nipples for several days/weeks, you should notice your nipples protruding more and becoming less flat. Your baby will still have to suck vigorously for it to work but don't worry about that because, after several weeks of practicing this technique, the nipple should remain in the baby's mouth even if he/she does not suck vigorously.
If both your breasts are flat or inverted, you can start with one side first by drawing out only one nipple at a time so that when you latch a baby onto that breast after step 3, his sucking action will also draw out the other nipple (repeat steps 1-3 on the second breast). Remember to be patient because even if both sides do not respond to the above method, in the beginning, they will eventually get better over time.
Why do you need to increase nipple size for feeding a baby?
Bigger nipples help the baby to latch on and draw out milk more easily. Flat/inverted nipples make it difficult to breastfeed (or even the fear of not being able to breastfeed) which, in turn, can trigger early weaning. Remember that you do not need huge areolas or long nipples to breastfeed - all you need is for your baby's mouth to fit around your nipple comfortably!
Moreover, bigger nipples during breast pumping will give a stronger let-down reflex and increase milk flow. This will also prevent you from getting sore nipples during breast pumping.
How can you know that your nipples are of the right size?
If your baby is latched on correctly, you should see some of the white parts of the areola being drawn into his/her mouth. If he/she has to work too hard to latch on or if only the tip of the nipple enters her mouth, it means that your nipples are too short and need to be drawn out more.
The sign that your nipples are too small or inverted is that your baby cannot latch on at all or has only the tip of the nipple in his/her mouth.
How to make your nipple size bigger?
- Use nipple formers:
This is a plastic or rubber insert that is worn inside your bra between nursing pads. It prevents the nipple from being compressed and flattened against the chest wall, thereby preventing it from getting shorter and wider. The formers come in different sizes - use a bigger size if you have larger breasts or a smaller one if you have small breasts.
- Use breast shells:
These are thin circular foam discs that separate your nipples from your upper chest to prevent them from getting short/flattened while sleeping on either side. These shells work in such a way that they need to be worn only at night. If you are not comfortable using them for 24 hours straight, you can wash them in warm water after each nursing session.
- Use nipple shields:
These are plastic cups that fit around your nipple and areola. They come in different sizes - use the appropriate size so they don't affect your baby's latch or cause any irritation around his/her mouth. Different brands of nipple shields have varying thicknesses so it is important to find one which does not press too hard against your breast tissue when the baby sucks.
- Feed from both sides during each feeding session:
If your baby latches on correctly or sucks for at least 20 minutes, you should exclusively breastfeed from only one side during each feeding session. The other side should be used as a comfort/pacifier feed.
- Hand express:
Your nipples will likely get longer and bigger when you do this. Expressing your nipples will help them to grow longer and produce milk more easily.
When your baby latches on, press down with your finger around the nipple area using firm but gentle pressure to flatten your nipple against the roof of his/her mouth. This will make them appear wider and shorter without getting any droops. Be careful not to use excessive pressure as it can damage your nipples.
Pressing down also helps stimulate milk flow which means that if you practice this technique several times a day (especially before breast pumping), your let-down reflex will be triggered earlier and improve milk supply.
- Breast pump usage:
Your nipples will become bigger and appear wide/flattened if you pump frequently. Therefore, ensure that you only use a breast pump occasionally (1-2 times a day) and if your baby is unable to latch on or is uncomfortable (but still latches on and sucks for at least 20 minutes).
- Stimulate the nipples:
When your nipples are hard/erect, you should apply some pressure to it using your fingers. Doing so will improve blood circulation and encourage the nipple to grow outwards.
- Nursing tea:
You can also use nursing tea which stimulates the let-down reflex. It is very cheap but only works if you drink at least 4 cups a day. Note that both of these methods may take 1-2 months before results appear (or not work at all). Such teas contain fenugreek which stimulates the flow of breast milk.
- Breast massage:
Massaging your breasts is an easy way to make them grow. Use a warm compress and rub your nipples in circular motions from right to left for 5 minutes each time. You should repeat this 2-3 times a day, preferably after every feeding session. The weight of the baby, while he/she is nursing, can also help with nipple growth as it stretches the skin around the areola and pulls it forward.
How often should you practice the above techniques?
To begin with, try applying pressure right before latching your baby onto one breast for 1 - 5 days. When this becomes easy, work on the other side too by pressing down both sides right before latching your baby onto each breast for another 1 - 5 days. Then, work on drawing out flat/inverted nipples into somewhat of a nipple shape right before latching your baby onto each breast for 1 - 5 days.
When this becomes easy, work on lengthening your nipples right before latching your baby onto each breast for another 1 - 5 days. This is the order in which you should do these four techniques. That way, you won't get confused and need to start over again when you've already completed one step.
If you want to increase the nipple size for feeding your baby, these are some of the methods you can use that don't involve pills or surgery. Be consistent with applying pressure before feeding your baby and massage your breasts regularly for faster results.