More Breast Feeding Problems
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Breast Feeding Problems 6
Retractile or Flat Nipples
Mum’s nipples come in
many shapes and sizes. While most nipples protrude and
are easy for baby to grasp, there are some variations in
size and shape that make it difficult for them to nurse
successfully. In order for a baby to nurse effectively,
he must be able to grasp the nipple and stretch it
forward and upward against the roof of his mouth.
or inverted nipples may make it difficult for your baby
In women who are
pregnant for the first time, it is very common for the
nipple to not protrude fully. About one third of mums
will experience some degree of inversion, but as the
skin changes and becomes more elastic during pregnancy,
only about ten percent will still have some inversion or
type of breast feeding problem; by
the time their baby is born. The degree of inversion is
likely to become less with each subsequent pregnancy.
Because your baby forms
a teat not just from the nipple but also from the
surrounding breast tissue, most inverted or flat nipples
will not cause breast feeding problems during nursing. Some
types of flat or inverted nipples will cause problems,
however, and there are some steps you can take to help
correct the problem both before and after the baby is
The first thing you
need to do is determine whether your nipples really are
flat or inverted. You can do this while you are
pregnant by performing a simple “pinch” test:
breast at the edge of the areola between your thumb and
Press in gently but firmly about an inch behind your
nipple. If your nipple protrudes, that’s great. If it
does not protrude or become erect, it is considered
flat. If it retracts or disappears, it is truly
inverted. Nipples that are severely flat or inverted
will not respond to stimulation or cold by becoming
erect. If you perform the pinch test and your nipples
protrude, they aren’t truly inverted and will probably
not cause any problems when you nurse your baby.
Differently to other breast feeding problems rectractile
or flat nipples have some particular characteristics.A
truly inverted nipple is caused by adhesions at the base
of the nipple that bind the skin to the underlying
tissue. While the skin does become more elastic during
the third trimester of pregnancy in preparation for
nursing, some of the cells in the nipple and areola may
Sometimes the stress of vigorous nursing
will cause the adhesion to lift up rather than
stretching or breaking loose, and this can cause cracks
in the nipple tissue and pain for mum.
Because the breasts
function independently of each other, it is not unusual
for a mum to have one flat or inverted nipple, or to
have one nipple that protrudes more than the other. For
the same reason, it is not unusual for a mum to produce
more milk from one breast than the other.
degree of inversion varies greatly,
ranging from the
nipple that doesn’t protrude when stimulated, but can be
pulled out manually, to the severely inverted nipple
that responds to compressions by disappearing completely.
How much difficulty a
flat or inverted nipple presents to a nursing baby
depends on the degree of inversion as well as the baby
himself. If you have a strong, healthy, full-term,
he may be able to draw out the nipple and dislodge the
attachments with relative ease.
discover that your nipples are flat or inverted before
your baby is born, you may want to use breast shellsfor
this breast feeding problems.
These are plastic cup shaped shells that exert a
constant, gentle pressure to the areola during the
period of pregnancy when the skin is most elastic. They
are worn inside your bra, which may need to be a size
larger in order to accommodate the shell.
The consistent, painless pressure exerted by the shells
may help break the adhesions under the skin that keep
the nipple from protruding.
Begin wearing them for a few hours a day, starting in
the last trimester. As you become used to them, increase
the time until you are wearing them all day. You should
not sleep in them. Remove them before going to bed, wash
them, rinse, and air dry them overnight. Any colostrum
that collects should be discarded. They should be
emptied frequently and washed every day. Shells come
with disposable pads that absorb the leakage.
After your baby is
born, you may want to wear the shells for 30 minutes
before nursing in order to help draw the nipple out
Once again, any milk that collects during usage
should be discarded
and not given to your baby.
The Hoffman Technique
is a manual exercise that may help break adhesions at
the base of the nipple that keep it inverted. Place the
thumbs of both hands opposite each other at the base of
the nipple and gently but firmly pull the thumbs away
from each other.
Do this up and down and sideways. Repeat this exercise
twice a day at first, then work up to five times a day.
You can do this during pregnancy to prepare your
nipples, as well as after your baby is born in order to
draw them out. This excercise can really help you solve
this breast feeding problem.
Gentle manual or oral
stimulation of your nipples can be a part of lovemaking,
and may encourage your nipples to protrude. Your
partner will enjoy helping you prepare your nipples for
After your baby is
born, you can use a
breast pump to draw out a flat or
inverted nipple immediately before putting your baby on
the breast. Pumping can also be useful in order to
break the adhesions under the skin by applying uniform
pressure from the center of the nipple. If the nipple
is truly inverted, (which is usually present in only one
nipple rather than both), you may need to use the pump
to provide stimulation and supplement with your milkand
turn this breast feeding problem around.
This is especially the case if the inversions are
present in both nipples. Usually, after the first few
the baby’s vigorous sucking will exert
negative pressure and help the tissue protrude.
both flat and inverted nipples, the baby will become
better at grasping and drawing the nipple into his mouth
as he gets bigger and stronger.
breast feeding problem as in every single breast feeding
problem, either if you have sore nipples, breast
engorgement or flat nipples REMEMBER!, it is helpful if
you have help from a Lactation Consultant. If possible
during the first feedings, as these are likely to
present most of the
problems. (more about
Lactation Consultant, click here)
Useful techniques include:
Stimulating your nipple.
Unless it retracts completely, grasp the nipple and roll
it between your thumb and index finger for 30 seconds,
then touch it with a moist, cold cloth immediately
before offering it to your baby. A disposable nursing
pad that is dampened and put in the freezer makes a
great ice pack to help the nipple evert immediately
Pulling back on the
areola before you latch the baby on.
breast with your thumb on top and your other fingers
underneath, and pull back on the breast toward the chest
wall. This will help the nipple protrude.
Using a nipple shield.
This is a thin, flexible silicone nipple with holes in
the end that fits over your nipple during feedings.
Nipple shields got a very bad reputation years ago when
they were made out of thick rubber, and caused a
significant decrease in the mum’s milk supply.
They were handed out freely to new mums in order to
‘reduce nipple soreness’ or to get babies to nurse at
the breast. Under these circumstances, they created more
breast feeding problems than they solved.
While nipple shields should only be
used when a lactation professional recommend and
supervises their use, they can be helpful in certain
situations. They should be used cautiously, since their
misuse can cause a decrease in the amount of milk the
baby receives, as well as causing nipple confusion.
Mums who use the shield should be instructed on how to
wean the baby off the shield as soon as possible, and
should weigh their baby frequently to assure adequate
For many mums, use of a shield is the first step in
getting her baby to nurse at the breast, and may mean
the difference between continuing to nurse or weaning.
The mums ability to feel her baby sucking at her breast
may encourage her to continue nursing after other
attempts have failed. The mum needs to be encouraged to
periodically put her baby on the breast without the
shield until she is able to discontinue its use
entirely. If the baby will take one breast without the
shield, she should nurse him on that breast at each
feeding, and use the shield only if the baby won’t take
the other breast without it.
While some babies move quickly from nursing with the
shield to nursing without it
(sometimes after only one
or two feedings) other babies have to be weaned from it
My niece, who had one normal nipple, and one that was
severely inverted, used the shield on and off for
several months. She monitored her baby’s weight gain
carefully, and he is now happily nursing (without the
shield) at the age of 18 months. Considering the
severity of her inversion, I am not sure that her baby
would have ever been able to nurse on that breast
without the use of the shield.
One of the situations in which a nipple shield can be
useful is in helping an infant latch on to a severely
inverted or flat nipple, especially when other measures
described above have failed.
While use of a nipple shield should only be considered
when other measures have failed, it can be a useful tool
under the guidance of an experienced lactation
In Parenthood-Parenting-Tips I made my best to include
the most valuable nipple shields in the market. I
included nipple shields of several sizes and types like
thin, flexible, silicone nipple shields.
The Great Advantage; Because the shields are made of
silicone, there is no risk of latex allergy. The thin
silicone layer means that more stimulation reaches the
areola, and the reduction of milk volume is minimized.
They also make a Contact Nipple Shield, which includes
an open cut-out section which helps the baby maintain
more skin contact with your breast.
During your initial feedings, your baby may be able to
open his mouth wide enough and suck vigorously enough to
draw the nipple far into his mouth and close his gums on
the areola, so the flat or inverted nipple may not
present a major problem.
Having someone to help you with latch on and positioning
can be very helpful.
You will want to nurse as soon as possible after birth,
and every 2-3 hours after that. You want to avoid one
breast feeding problem you already know about, yes, you
have it in your mouth, you want to avoid engorgement,
because breast swelling can cause the nipples to flatten
out, making them more difficult to grasp.
During the initial learning period of breast feeding,
avoid the use of any artificial nipples.
Supplement with alternative feeding methods, because the
baby who is learning how to nurse, especially on a
nipple that isn’t the ideal shape for nursing, is more
likely to become nipple confused.
If breast feedings become stressful, stop and comfort
your baby. Try rocking, swaddling, walking, giving him
your finger to suck, or offer him some expressed milk
(or water or formula) until he settles down. You want
him to associate feedings with positive feedback, not
Supplementing your baby or using a nipple shield
temporarily is preferable to having a baby who screams
every time you open your nursing bra.
Many mums with flat or inverted nipples experience some
degree of nipple soreness.
As you saw when we explained about this breast feeding
problem, you MAY experience soreness as the nipple is
drawn into the baby’s mouth, and the adhesions are
stretched or broken. If the nipple draws back into the
baby’s mouth during or immediately after feedings,
moisture may become trapped and contribute to soreness.
Try patting the nipples dry after feedings and apply a
thin coating of Purelan 100 (ask for free .25 oz. tube
with any order). See the article on “Sore Nipples” for
more treatment options.
If the soreness lasts for more than a week or two, you
may need to use a high quality pump (such as the
Lactina, the Classic, or the PumpIn Style to help
maintain your milk supply.
When a nipple is severely inverted, the baby may
compress the nipple buried inside the tissue, rather
than the milk sinuses underneath the areola. The sucking
action of the pump pulls out the center of the nipple
uniformly, rather than compressing the areola. This can
help gradually break the underlying adhesions.
If both nipples are severely inverted (which is not
usually the case) you may need to double pump every 2-3
hours and feed your baby with an alternative method
until the adhesions are broken and the nipples protrude.
In some rare cases, the baby never successfully goes on
the breast and you may need to continue pumping and
feeding expressed breastmilk by bottle.
Usually, only one nipple is inverted and one breast is
easier for the baby to grasp. In this case, you may want
to feed on the ‘good side’ while you pump the other
breast until the adhesions are loosened. You can feed
the baby the milk you expressed on the inverted side
after nursing on the other breast.
Some mums can draw their inverted nipples out with just
one pumping session.
Others may need to continue pumping for days, weeks, or
even months, depending on the degree of inversion and
the baby’s sucking patterns. If the nipple inverts again
during pauses in the baby’s feeding, you may need to
stop and pump again for a few minutes and then put him
back on the breast. In almost all cases, the adhesions
will loosen and the baby will be able to nurse
effectively as he grows bigger and stronger and becomes
more efficient at nursing.
Further breast feeding problem is Mastitis which occurs
when the breast becomes infected. Usually mastitis forms
as a red, tender and swollen area of the breast. Many
mums develop a fever, chills and other flue like
If you develop mastitis, your doctor will likely
prescribe antibiotics to remove the infection. You may
also need to take anti-inflammatory agents to help
reduce pain and discomfort. It is important you continue
breast feeding during this time to help relieve the
Breast Feeding Problems 8
Breast abscess usually
develop in mums who have a history of breast feeding problems
including mastitis. This condition usually results from
improper early treatment of mastitis. Signs of an
abscess are similar to the signs of mastitis,
including a red, tender and swollen area of the breast.
Usually patients with a breast abscess will need to take
antibiotics and drain the abscess using needle
aspiration. In some severe cases incision and drainage
of the abscess may be necessary.
Breast Feeding Problems 9
Some mums have an overactive
milk ejection reflex. This occurs when milk production
and ejection occurs at a rate that is too fast for the
baby to swallow effectively. If this is a problem your
baby may cough and gag when your milk lets down.
Usually nursing your baby in a
semi-upright position helps relieve this problem.
You may also limit the amount of milk ejected by
compressing the ducts during the first few minutes of
Breast Feeding Problems 10
mums experience some breast feeding problems when they
start weaning. Most doctors and healthcare organizations
recommend you breastfeed your baby for at least the
6 Months of Life. Human milk is the best food for
You can wean
successfully if you do so gradually. One way to do this
is to stop one breast feeding session each day every four
to five days. Most mums will cut out the midday feeding
initially until they work themselves up to zero sessions
every day. After babies are 6 months old they can start
drinking cows milk in most cases.
Some mums wean there baby to
a bottle and then a cup whereas others wean their baby
direct to a cup. Engorgement is the most common problem
associated with breast feeding.
Usually you can avoid this if you wean gradually over a
longer period of time.
You should avoid pumping when weaning to prevent your
breasts from overproducing milk during weaning.
Later Breast Feeding Problems
breast feeding is established most mums and babies will
go on to enjoy a healthy breast feeding relationship.
There is a chance your baby may start biting after he or
she starts growing teeth.
this is a common breast feeding problem. Normally
happens when your baby is four to ten months old. Biting
the nipples can cause pain and injury. Fortunately you should be able to teach
your baby not to bite your nipple simply by removing
them from your breast immediately after biting for a
short time.This is not really a breast feeding
Remember, even the seemingly
worst breast feeding problems can usually be overcome
with a little patience and care. If you are having
trouble breast feeding, be sure to consult with a
lactation consultant or your doctor, who can help you
solve any latch on problems and help you set up a joyful
and rewarding breast feeding relationship with your
baby. I made my best to give you a complete list of the
main breast feeding problems you may experience with
your precious baby. REMEMBER, every breast feeding problem
can be solved in some way. Lactaction consultants are
waiting for your enquiries about breast feeding
problems, make use of their experience to guarantee a