Breastfeeding: Can you nurse with inverted nipples?

I would like to try breastfeeding, but I have inverted nipples. I know it is possible to nurse, from talking with my doctor and my mother (my grandmother had them also and breastfed four children.) What are some of the challenges I might face?

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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

Inverted nipples don't need to be cause for concern. Pregnancy is a time of substantial breast development and growth, and moms-to-be with previously flat or inverted nipples may find their nipples do extend as it gets closeer to the birth. Nipple extension also improves with each pregnancy and breastfeeding experience.

When you are in your last trimester of pregnancy you can check your nipples. Compress your areola at the base of the nipple. Using your thumb and forefinger, 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. Truly inverted nipples are rare.

If, as you enter your third trimester, you find that your nipples still do not extend, you might want to wear breast shells. Breast shells are made of hard, lightweight plastic and consist of two rings. The inner ring applies a steady, gentle pressure on your nipples, stretching the adhesions that keep them from protruding. Begin wearing the shells for an hour or two a day, increasing gradually, until you are wearing them all day. Only wear as long as they remain comfortable. You might find that you need to buy a larger bra size to accommodate this new shape.

Just as your grandmother was able to nurse all four of her children, you too can breastfeed with inverted nipples. It is not necessary to have extending nipples to nurse successfully. 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 your nipple and wait until his mouth is open as wide as a yawn. It may help to pull back slightly on your breast tissue, keeping your thumb and fingers back from the areola as your baby latches on. Your baby needs to take a good portion of your areola into his mouth, bypassing your nipple. When your baby is properly positioned and attached, he will form your breast tissue and be able to suckle.

There can be challenges to nursing with inverted nipples. Babies born to moms with inverted or flat nipples are particularly prone to nipple confusion when offered artificial nipples in the early weeks of breastfeeding. When your baby is born, putting her to your breast as soon after the birth as possible is very helpful in "imprinting". She becomes accustomed to your breast and nipple shape. In most cases, your baby can be placed immediately on your chest. Allow her to lick and nuzzle your nipple, attaching if desired. Babies who have been given the opportunity to suckle immediately following birth seem to do better at the breast, even when their mom's nipples do not protrude. Avoid the use of artificial nipples (including pacifiers) until nursing is well established (at least a couple of weeks). If supplementation becomes necessary, syringes or cups can be used from birth, while working on the breastfeeding relationship.

Make sure you have help from the hospital's nurses and lactation consultant so you can get positioning and attachment right from the start. Get in lots of practice sessions breastfeeding in those early days while your breasts are soft and easily graspable. You may also find it helpful to hand-express or pump for a couple of minutes prior to putting your baby to your breast. This helps to get your milk flowing, and expressing a few drops onto her lips can be very enticing.

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