Large breasts with flat nipples

I have very large breasts and areolas, but very small and very often flat nipples. I had difficulty nursing my first baby. She couldn't take any part of my areola or the nipple. I tried to use nipple shields but that was a big torture for me and my baby and she didn't gain any weight. I am going to be nursing my newborn who is due in 12 weeks but don't know how. Can you help?

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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

It is great to hear that you are planning ahead for your new baby. During the last trimester of pregnancy you might want to try using breast shells. They are often recommended to help draw out flat or inverted nipples. Breast shells are made of hard, lightweight plastic and consist of two rings. The inner ring applies steady, gentle pressure on your nipple, stretching the adhesions that are keeping it from protruding. Begin to wear the breast shells for an hour or two a day. Increase the amount of time gradually, until you are wearing them all day (or as much of the day as is comfortable.)

It can be a challenge to nurse your newborn when you have large breasts and flat nipples. Your nipples will probably extend more readily following your new baby's birth than they did with your first. Though your nipples may seem flat at this point in your pregnancy, once your baby is born and begins to nurse, they will probably be easier for your new baby to grasp than they were for your first. This should help to make breastfeeding easier for you.

After the birth it is important to put your baby to your breast as soon as possible. Even if she decides she is not ready to latch-on and nurse at that time, she will smell and nuzzle and lick your nipples. This really seems to have an imprinting effect on the newborn. This will help her to learn to nurse. Though it is important for all babies to have early access to the breast, it seems to be especially helpful for babies whose moms have flat nipples.

As you begin nursing, be patient. Perfect latch-ons may not be occurring right from the start. Give your new little one a lot of practice time at your breast. If she becomes frustrated (or if you do) gently remove her from your breast, calm (everyone) down, and try again. Allow her a lot of skin-to-skin contact. You want her to be happy at your breast.

If your baby is having difficulty latching-on, using a pump for a few minutes prior to the feed will help to extend your nipples and get your milk flowing. Express a little of your sweet milk onto your nipple so she can taste it. Tickle her lower lip with your nipple, until she opens wide, and hug her in quickly to your breast. It is really important that she take a good mouthful of your breast.

If you are feeling engorged, if your baby has not had good feeds, and/or if she is not wetting diapers and stooling, it is really important that you express your milk with a hospital-grade electric breast pump. (Some basic guidelines for the first three days -- on day one your baby should be wetting two diapers, and having two bowel movements; day two, three wet diapers and 2 bowel movements; day three, at least three wet diapers and 3 bowel movements.)

The milk that you express should be fed to your baby, using a cup, spoon or syringe. Avoid the use of bottles and pacifiers in the hospital and at home during the first 6 weeks. It can be especially hard for babies to go back and forth between artificial nipples and the breast when their mom has flat nipples.

Nipple shields can cause problems, as you saw with your first baby. They must be used with caution because they can seriously diminish your milk supply. This may lead to slow weight gain, failure-to-thrive, or worse. Nipple shields can work wonders when used as a stopgap measure to get a baby to the breast, but I would only advise their use when working in conjunction with a Lactation Consultant who will be closely following your case. I also would not advise using them during the first few days of your baby's life. Give your new baby the chance to learn how to breastfeed. Best wishes!

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