Inverted nipples can make breastfeeding more difficult and painful but often women think they have inverted nipples when they actually do not. Some women have flat nipples that are not truly inverted. These types of nipples can also present challenges, but these nipples are distinctly different from inverted nipples. Usually flat nipples are a temporary problem as a result of other factors such as postpartum swelling. Many women are told they have inverted nipples immediately after delivery and the majority of the time they are given a nipple shield without any assistance on using it properly. This can be problematic for several reasons. First of all, the use of a nipple shield should be limited and only used when necessary as they may limit the infant’s ability to transfer milk or may inhibit the stimulation needed to signal your body to produce more milk. Secondly, nipple shields are like a Band-Aid. They may be a temporary fix, but they also may mask what is really causing your problems. Here are some things you can do to help you succeed at breastfeeding if you have inverted nipples.
1. Make sure you have inverted nipples. Inverted nipples are rare and occur in approximately 3% of women (Park et al., 1999). Many times mothers are diagnosed with inverted nipples right after they deliver their babies. In many of these cases the nipples are flat due to excess fluid retention from labor and delivery. Flat nipples can be drawn out by rolling the nipple between your fingers or by pumping right before you breastfeed. Excess fluid can make it difficult to draw out a flat nipple or allow the infant to latch easily. Before you try to draw the nipple out, reverse nipple compression should be done in order to push the fluid away from the nipple.
2. Know the difference between flat and inverted nipples and find out which type of nipples you have. Flat nipples are not the same as inverted nipples. Typically, a common nipple will protrude some while at rest but will become more erect when stimulated. Flat nipples may not protrude while at rest, but with enough stimulation they can become more erect and will maintain shape in the infant’s mouth which will make it easier for the infant to latch. Inverted nipples have the appearance of being turned in. There are three different types of inverted nipples. A pseudo-inverted nipple has the appearance of being inverted but it will become erect with enough stimulation. A retracted nipple is trickier. They appear erect, but when they are stimulated they invert. Retracted nipples will respond well to stimulation. The last is a truly inverted nipple. They remain inverted whether they are stimulated or not. You may be able use your breast tissue to help form a nipple inside the infant’s mouth.
3. Some mothers may experience severe pain or cracked and bleeding nipples. If you experience any nipple pain seek help from a health professional who is experienced in lactation. If the infant is having a hard time forming a nipple with your breast tissue or you are experiencing extreme pain due to nipple inversion, a nipple shield may work well for you. However, you should always work with a lactation consultant before deciding to use a nipple shield.
ILCA. Eds. R Mannel, P Martens & M Walker. (2013) Core Curriculum for Lactation Consultant Practice. (3rd Ed) Jones & Bartlett.
Park, H.S., Yoon, C.H., & Kim, H. J. (1999). The prevalence of congenital inverted nipple. Aesthetic Plastic Surgery, 23, 1446.