Treatments For Flat Or Inverted Nipples, and Techniques To Make Latching Easier
Although opinions and experiences vary, many women have found treatments for inverted or flat nipples helpful and many breastfeeding experts continue to recommend them. Breastfeeding experts disagree on whether pregnant women should be screened for flat or inverted nipples and whether treatments to draw out the nipple should be routinely recommended. For example, the British Royal College of Midwives says that hormonal changes during pregnancy and childbirth cause many mothers' nipples to protrude naturally. Although treating flat and inverted nipples during pregnancy is debated, if your newborn is having difficulty latching on to a flat or inverted nipple you may find some or all of the following helpful.
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Breast shells
Worn inside your bra, breast shells may help draw out flat or inverted nipples. Breast shells are in two pieces and are made out of plastic. The inner piece has a hole that fits over the nipple. The pressure on the tissue around the nipple causes the nipple itself to protrude through the hole. Breast shells may be worn during pregnancy to take advantage of the natural increase of the elasticity of a woman's skin by applying gentle but steady pressure to stretch the underlying adhesions (connective tissue) and draw out the nipple. After birth, they can be worn for about a half an hour before feedings to draw out the nipple. They should not be worn at night, and the milk collected while wearing them should not be saved.
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Hoffman Technique
This procedure may help loosen the adhesions at the base of the nipple, and can be used during pregnancy as well as after the birth. Place a thumb on each side of the base of the nipple -- directly at the base of the nipple, not at the edge of the areola. Push in firmly against your breast tissue while at the same time pulling your thumbs away from each other. This will stretch out the nipple and loosen the tightness at the base of the nipple, which will make it move up and outward. Repeat this exercise twice a day, working up to five times a day, moving the thumbs around the base of the nipple.
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Breast Pump
After birth, an effective breastpump (See How Do I Choose a Breast Pump? for more information on pumps) can be used to draw out the nipple immediately before breastfeeding. This makes latching easier for baby. A pump can also be used at other times after birth to further break the adhesions under the nipple by applying uniform pressure from the center of the nipple.
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Evert-it™ Nipple Enhancer
Designed by lactation consultants, the Evert-It™ consists of a syringe with a soft, flexible tip made of silicone, either end of which may be used to provide suction to help nipples protrude for easier latch-on. Use it before feedings as you would a breast pump.
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Nipple stimulation before feedings
If the nipple can be grasped, roll the nipple between the thumb and index finger for a minute or two. Afterwards, quickly touch it with a moist, cold cloth or with ice that has been wrapped in a cloth. This method can help the nipple become erect. Avoid prolonged use of ice, as numbing the nipple and areola could inhibit the let-down reflex.
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Pulling back on the breast tissue during latch-on
As your hand supports the breast for latch-on with thumb on top and four fingers underneath and behind the areola, pull slightly back on the breast tissue toward the chest wall to help the nipple protrude.
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Nipple shield
A nipple shield is a thin, flexible silicone nipple that is worn over the mother's own nipple. It has holes in the tip to allow milk to flow to the baby. If other strategies are not working, a nipple shield could help baby latch on and nurse well by providing the stimulation to the roof of the baby's mouth that signals his suck reflex. Nipple shields should only be used with the guidance of a lactation professional as they can lead to problems if not used properly.