Breastfeeding: Can you nurse with flat nipples?

I am five months pregnant, and a bit worried about breastfeeding. My nipples are almost flat, and although I have been trying to "stretch them" as my doctor recommended, I don't see much change. Will this cause a problem with breastfeeding?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

You can breastfeed successfully if you have flat or inverted nipples.

If you are in your last trimester of pregnancy compress the areola at the base of the nipple, using your thumb and pointer finger and press in toward your chest. If your nipple stays the same, rather than protruding, you have flat nipples. If this pressure causes your nipples to draw inward, they are inverted.

As breast changes occur during pregnancy, some previously flat or inverted nipples may begin to protrude. Usually these changes occur by the seventh month. If your nipples remain flat or inverted, I would recommend using breast shells at this time. (Check with your health care provider if you have a history of premature births.) Breast shells are made of hard, lightweight plastic and consist of two rings. The inner ring applies steady, gentle pressure on the nipple, stretching the adhesions that stop it from protruding. Begin wearing the shells for an hour or two a day, increasing gradually, until you are wearing them all during the daytime hours. Do not wear longer than comfortable. You may need to get a larger bra size to accommodate the dome shaped outer ring that protects the emerging nipple.

If you have not worn breast shells during the last trimester of your pregnancy, it's not too late. Breast shells can still be worn for about one half hour before nursing to help draw out your nipple.

When you have non-protruding nipples it is especially important to breastfeed early and often. Babies who have been given the opportunity to suckle immediately following the birth seem to do better at the breast, even if their mom's nipples do not protrude. Wait ti introduce a pacifier until breastfeeding is well established (usually after a few weeks). Get in lots of practice sessions breastfeeding in those early days while your breasts are soft and easily graspable.

To help draw your nipples out prior to those early feeds, you can use a breastpump for a few minutes. Expressing a few drops of your milk onto your baby's lips will help entice him to nurse.

The shape of your nipples "at rest" does not determine the amount they will protrude as your baby nurses. Proper positioning is crucial. Tickle your baby's lips with yournipple and wait until his mouth is open as wide as a yawn. It may help topull back slightly on your breast tissue, keeping your thumb and fingers back from the areola as your baby latches on. This may help your nipple to protrude. Your baby needs to take a good portion of your areola into his mouth.

If you are having any breastfeeding difficulties, get help from a lactation consultant in your area who can thoroughly assess your situation and teach you to position your newborn. Find one at: www.ilca.org.

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