Today, an expectant mother asked me what she could do to prepare her breasts for breastfeeding. This is a common question, so I thought I might address it here with our group.
The most important thing a mother can do is to check to be sure she doesn’t have inverted nipples. Inverted nipples are those that retract (telescope in to the breast tissue) when the areola (brown area behind the nipple) is gently pinched together. The condition makes it difficult for a baby to latch correctly. If identified during pregnancy, treatment can be very effective in reducing the degree of retraction and facilitating an early attachment of infant to breast. So, if a mother thinks her nipples might be inverted, she can ask her doctor to check or call our lactation office for a recommendation.
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My husband and I attended your class and did the homework assignment. You mentioned that if indeed one had inverted nipples, I should buy the nipple shell. I was wondering should I use that shell now or wait until the baby is here?
ReplyDeleteHi Nancy! I’m so glad to hear from you! Your question is very important and answering it will give me an opportunity to elaborate on this condition more than I was able to in class.
ReplyDeleteBasically, inverted nipples can be one of two types: pseudo inverted or truly inverted (inverted meaning retracted in to the breast). A pseudo nipple inversion is where the nipple looks as if it is inverted, but can actually be everted (pulled out) by 1) compression of the areolar tissue between the thumb and index fingers or 2) negative pressure from a pump or similar device. If the nipple can be everted, then there should be little or no concern. However, when a nipple is truly inverted and cannot be pulled out, there are a couple of things that can be considered for treatment during pregnancy.
Breast Shells are hard plastic dome-like devices that fit over the nipple underneath a brazier. The cup of the bra places gentle pressure on the device, encouraging the nipple to protrude through a funnel-shaped opening underneath the dome. Beginning in the third trimester of pregnancy, they may be worn one hour per day, gradually increasing until they are worn throughout most of the day. It is important not to sleep in them. Also, care must be taken to avoid skin breakdown due to moist air and heat inside the shell, especially in hot weather. I should say that, depending on the degree of nipple inversion, the use of breast shells may or may not be effective. However, for some of us, they may be worth a try. Breast Shells are available for purchase in several places around the St. Louis area.
Another method of attempting to evert a nipple during pregnancy would be to perform the Hoffman technique, a nipple “exercise”. I tend not to recommend this very often as I have not been impressed with its results. Also, if a mother is at any risk of preterm labor, this exercise should not be used.
Mothers with truly inverted nipples should not be discouraged from breastfeeding. The most effective treatment will take place after delivery when baby will show us how well he can work his magic!
Nancy, I hope this helps. Thanks for writing!
Hi Diana,
ReplyDeleteI am finally 13 weeks pregnant. I have inverted nipples and I'm not sure I understand the pulling out option. I think i am truly inverted. Do I just try to find the Breast shells or do I try and see someone to find out. My ob directed me to this blog and said that you would be able to help. I want to do anything I can so I can breast Feed. Any help you can give would be great! Thank you so much.
Hello and congratulations on your pregnancy! You’ve made it over that first trimester hump. ☺
DeleteYour breasts will undergo some changes in the next few months, especially after 16 weeks when you will begin making milk… that’s right, your breasts will begin making milk very soon! However, do not expect to see anything (although you might) for quite some time. Many women never see evidence of colostrum being produced until after delivery.
As for true nipple inversion, a diagnosis may be made by gently compressing the areolar tissue (brown area behind the nipple) together with your thumb and index finger. Watch to see if the tip of the nipple protrudes outward or retracts into the breast. Keep in mind that nipples may change over the course of pregnancy. Those that appear flat or inverted, often elongate so that they are graspable for the infant by the end of pregnancy. Not everyone has success using shells to treat true nipple inversion, but shells are harmless and inexpensive. There are other devices available for purchase. However, these may or may not be safe for use. It is important to have a clinical breast/nipple examination before any “device” is recommended.
In any case, try not to worry. There are many “tricks of the trade” that may be helpful. I would be happy to see you for a prenatal assessment if you are concerned. Just call the lactation office (996-5747) and ask to speak with me.
Thanks for writing!
Diana