Breastfeeding - Management of Common Breastfeeding Issues

Inverted/Flat Nipples

At some point towards the end of your pregnancy, your obstetrician or midwife should have evaluated your breasts and nipples for any problems that might interfere with breastfeeding. You can assess your nipples at home to determine if you have flat or inverted nipples by performing the following pinch test.

• Place one hand around your breast with your thumb above the areola and your fingers below the areola.
• Pull your fingers backward (into your chest) slightly to make the nipple thrust out.
• If your nipple does not thrust out, or dimples in then you have flat/inverted nipples.

Not all women with this problem need to be treatment. There are varying degrees of nipple inversion. Treatment for flat/inverted nipples can begin towards the end of pregnancy. Breast shells can be worn for a few hours each day to force the nipple to protrude out. However, use of breast shields should be discussed with your obstetrician or midwife because they care contraindicated in certain women during pregnancy. After birth, breast shells can be used as needed. Other suggestions that may help with flat or inverted nipples include:

• Roll you nipple between your finger and thumb just prior to latching on your baby. This will stimulate the nipple into an erect state.
• Use a pump just prior to latching on your baby. This will pull the nipple out as far as possible, giving your baby a little more to grab.
• In some women, use of a nipple shield may be warranted. A nipple shield is a silicone "nipple" that is placed over the mother's nipple. Nipple shields should not be used unless under the direction of a lactation consultant. Prolonged use of a shield leads to decreased milk and growth problems in babies.