The Nursing Baby Larry's Flat or Inverted Nipples FAQ

I have posted this FAQ on numerous occasions in both misc.kids.pregnancy and misc.kids.breastfeeding. I have received a number of responses thanking me for raising consciousness about this possible problem.

I have also received questions asking whether nipple stimulation could cause pre-term labor.

The kind of nipple stimulation described in this article is less intense than, for example, orgasm from engaging in sex while pregnant. It is generally accepted medical practice practice NOT to contraindicate sex during pregnancy. For that reason, it is my opinion that there is no more reason to contraindicate the techniques I describe for correcting flat or inverted nipples.

If pre-term labor has been identified as a preexisting problem or if you have a condition (multiples, for example) that predisposes you to pre-term labor, you should avoid the nipple stimulation described in this article.

On the other hand, if you are having a normal pregnancy and have no known disposition to pre-term labor, there is no reason not to use the methods described in this article.

Newsgroups: misc.kids.breastfeeding Subject: Re: inverted nipples-success stories? (long)

Yet another inverted nipple sufferer posts asking advice and if anyone has had success solving the problem. I respond for three reasons.

• To say there ought to be a FAQ on this, it IS a frequently asked question.
• To say YES, Monika had severely inverted nipples before Clara was born. We recognized the problem WHEN she got pregnant, and we solved it.
• To say that solving the problem is not rocket science. Solving the problem is quite simple, but like all issues of reshaping the body, it takes time! You can't go into it expecting to change overnight!

First, the human body is quite elastic (stretchable) and quite plastic (reshapable) with the exception of bone, which is quite rigid. This is the first thing to note.

Inverted nipples are usually a result of the ligaments along the milk ducts which run to the nipples (and the ducts themselves) as shorter than the distance from from the center of the breast where they originate to the nipple. Hence they pull in end of the nipple in toward the center of the breast, inverting it. This is the second thing to note.

Since the tissue is stretchable, if you can get hold of the end of the nipple, you can pull it out to a protruding position. The problem is that as soon as you let go, it goes back to the inverted position. However, each time it goes a little less far. Pull it out 100 times and it stays out a while, pull it out 1000 times and it may stay out permanently. Ths is the third thing to note.

These facts suggest a simple treatment. Pull the nipple out and hold it in a protruding position as LONG as is comfortable, then rest and do it again as soon as it is recovered from the exertion. Repeat over a period of time. And this is like both orthodontia and politics: A small force over a long period of time accomplishes more than a large force over a short period of time.

Now. Some practical ways to accomplish this treatment...

1. Get a hospital grade breast pump (ie: one with a strong pull) and pump on the inverted nipples.
   1. You need to pump long enough to stretch the nipple out and hold it in the stretched position long enough for the internal ligaments to stretch somewhat. I would suggest at least 15-20 minutes per nipple (this is much longer than you need to pump to obtain milk after the baby is born).
   2. I would suggest observing to see if the pump is pulling the nipple out to a protruding position. If not, you need to get a stronger pump or use another method.
   3. I would suggest starting no later than your 30th week. This gives you 10 weeks to uninvert the nipple.
   4. I would suggest at least 2 to 3 pumpings per day. If you have more time, go for it.
   5. If you have not made SIGNIFICANT progress by week 36, then increase both pumping time and frequency or add another method.
2. Get DH to provide the same suction. Some people may find this offensive, but I think it is more effective for two reasons.
   1. It can be modified to suit the needs of the individual.
   2. It is more like what the baby will do than any other method.

   Here is the way I would suggest proceeding, if DH helps.

   1. Since this is more effective DH can suck 10-15 minutes on each breast.
   2. DH should make sure to get the entire nipple and at least half of the areole in his mouth and stretch out the nipple as far as is comfortable, while massaging the deep tissue under the areole with his tongue. This encourages the ligaments and ducts to stretch out more easily.
   3. Again, start by your 30th week.
   4. In this case you can start with once every second or third day, and work up to every day by 33 weeks and twice a day by 36 weeks, etc.
   5. I can't imagine not making progress by week 36 with this method. But again, to increase progress, increase sucking time and frequency.
3. Breast Shields. This is the LEAST effective way to uninvert nipples. Why? Because it does not apply ANY force to stretch the nipple out to a protuding position, it simply presses the rest of the breast mass back. For that reason, if you choose to use this method, I would suggest starting MUCH EARLIER than with the other two.

Both methods A and B can lead to sore nipples or tender breasts, expecially if they are not used to contact. In both cases I would suggest applying Lansinoh cream and waiting until the soreness subsides, at least from weeks 30 through 36. Beyond week 36 you have to trade off how much progress you have made in uninverting the nipple versus how tender you are. Another consideration is that the baby will want to nurse 8 - 10 times a day. If you can't stand sucking or pumping three times a day, you may well have pain problems feeding the baby. Better to endure a little discomfort early than a lot later on.

Monika and I used method B. We actually started earlier than 30 wks because Monika was quite anxious about being able to latch the baby on if her nipples were inverted. It took us about 10 weeks to "turn them right side out." Monika had the added benefit that she suffered no nipple soreness when the baby came. This was in contrast to the 5th or 6th week of turning her out when we had to rest a day because of a tender spot or hairline crack.

Why do I feel so strongly about this?

1. I am a strong breastfeeding advocate, and I hate to hear of women who want to breastfeed but can't because
   1. The baby can't latch onto the inverted nipple, or
   2. The nipple is so painful the mother can't stand to feed.
   I know both of the conditions can be avoided.
2. Even though we had reversed Monika's inverted nipples, Clara had difficulty latching on at first. This was quite stressful for both of us. If the nipples were still inverted it would have made the problem worse, and we may be in group 1, above.

This works! If you don't believe me ask Monika ( mmcmahan at home dot com).

As for the ones who have the problem, but only read this message just before the due date (or even after the baby is born), my heart goes out to you. Depending on the severity of your inversion, you may have to choose between enduring relatively more pain or not breastfeeding. However, anything you do NOW to solve the problem will be gentler than what the baby does.

If the baby is already here, I would suggest using the pumping method immediately after a feeding. If the baby is latching on at all, you are probably getting all the sucking you need, and any addition may well increase the soreness. The pump can hold the nipple in place with a little less force.

Good luck,
Larry


These tips are not intended to be medical advice. Please consult your healthcare provider if you have questions.