Every baby that comes into this world has custom-made nutrition readily available to them in the form of breastmilk, which not only provides nutrition, but also quenches their thirst and contributes positively to their immune and digestion systems. Doula and birth coach Leonie Mynhardt gives moms some great advice on nipple care and best practices to increase breastfeeding success.
To ensure your baby gets the optimal form of nutrition, it’s important to prepare your breasts and nipples for the demands of breastfeeding and to be prepared to timeously identify and treat possible problems that might arise. This will create a positive and successful breastfeeding journey for you and your little one.
Different shapes and sizes
Breasts and nipples come in all shapes and sizes, and usually all of them are suitable for breastfeeding. Remember that babies BREASTfeed, and not NIPPLEfeed. As long as a baby can take a good portion of the breast into his mouth (baby’s mouth and gums should bypass the nipple entirely and latch on to the areola), it should lead to successful breastfeeding. Some types of nipples (flat or inverted) are more difficult for a baby to latch on to at first, but in most cases, careful attention to latch and positioning, along with a little patience, will ensure that mom and baby get off to a good start with breastfeeding.
Flat or inverted nipples
You can determine whether or not your nipples are flat or inverted by doing a ‘pinch’ test. Gently compress your areola about 2cm behind your nipple. If the nipple does not become erect, then it’s considered to be flat. If the nipple retracts, it’s considered to be inverted. It should be noted, too, that true inverted or flat nipples will not become erect when stimulated or exposed to cold. If the nipple becomes erect during the pinch test, it is not truly inverted and does not need any special treatment.
Treatment and latching techniques for flat or inverted nipples
Although treating flat or inverted nipples during pregnancy is highly debated, you may find the following helpful if your baby is having difficulty latching on to a flat or inverted nipple:
- Breast shells
Worn inside your bra, breast shells may help draw out flat or inverted nipples. Breast shells consist of 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 in elasticity of a woman’s skin by applying gentle but steady pressure to stretch the underlying 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.
- Hoffman technique
This procedure may help loosen the connective tissue at the base of the nipple, and can be used during pregnancy as well as postnatally. 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, moving the thumbs around the base of the nipple.
- Breast pump
After birth, a breast pump can be used to draw out the nipple immediately before breastfeeding. This makes latching easier for baby. A breast pump can also be used at other times after birth to further break the connective tissue under the nipple by applying uniform pressure from the centre of the nipple. Ensure that the breast pump is fitted correctly to avoid strain to your breast and nipple.
- Nipple enhancer
A nipple enhancer 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.
- 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.
- Pulling back on the breast tissue during latch on
As your hand supports the breast for latch on – with your 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.
- Nipple shield
A nipple shield is a thin, flexible silicone nipple that is worn over the mom’s own nipple. It has holes in the tip to allow milk to flow through. 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 specialist as they can lead to problems if not used properly.
- Lactation specialist
A good lactation consultant is worth her weight in gold to a breastfeeding mom as she will be able to discuss any issues or concerns the mom might have and provide expert advice and support regarding the whole breastfeeding process.
Protecting your nipples during breastfeeding (or pumping)
- Correct position and correct latch
Even though some tenderness in the early days of breastfeeding is rather common, breastfeeding should generally not hurt. It is important for the baby to learn how to open his mouth wide and bypass the nipple, allowing his gums to close further back on the breast. Experimenting with different positions is a good way to find what is most comfortable for mom and helps baby latch most effectively. A correct latch is never painful. If a latch causes pain or discomfort, break the latch and try again.
- Breastfeed early and often
Plan to breastfeed as soon after birth as possible, and at least every two to three hours thereafter. This will help you avoid engorgement, and will allow baby to practise at latching and breastfeeding before the milk comes in. Lots of practice at breastfeeding while mom’s breasts are still soft often helps baby to continue to nurse well, even as the breasts become more firm. When you start breastfeeding, your nipples will be exposed to a strong vacuum up to 10 – 12 breastfeeding sessions every 24 hours. This may lead to soreness or even pain. Your nipples will get used to it very quickly and the soreness will pass. Make sure your baby is latching on properly from the very beginning and ensure that you take care of your nipples.
- Be patient and calm
Baby should not associate breastfeeding with unpleasantness. If baby becomes upset, immediately take a break and calm him. Offer a finger for him to suck on, then walk with, swaddle, rock, or sing to him. Wait until he is calm before trying again. If both mom and baby are calm, you’ll have a greater chance of a successful latch and a successful feed. The environment in which you breastfeed should also be peaceful and there should be no rush. Also try and feed the baby timeously before he gets too hungry, as this will cause the baby to be cranky and difficult to latch, and he may suck too vigorously and cause nipple damage.
- Caring for nipples
Take special care of your nipples during breastfeeding. You do not need to clean your breasts or nipples in a particular way before or after feeding your baby – just rinse your breasts with clean water during your daily bath or shower. Avoid soap, disinfectants and any substances that could dry or damage your skin, nipples or areolae. During pregnancy the Montgomery glands surrounding the nipple start to secrete natural oil that lubricates the skin and discourages the growth of bacteria. Just leave this natural substance to do its job. As a daily treatment for your nipples you may express a few drops of milk after feeding, massage it gently into the skin and let it dry. If your skin is especially dry or damaged, you may apply a small amount of purified natural lanolin to your nipples and areolae. If necessary, only use only baby-safe nipple creams (check instruction leaflets if it must be washed off before a feed). Expose nipples to sunlight daily for a short period. If your nipples are cracked, make use of nipple shields until they heal. Alternate baby between breasts during a feed; breaking the latch by putting your pinky into the side of baby’s mouth to prevent nipple damage. Use breast pads to absorb any leaking milk as it can irritate the skin if milk is not absorbed, and leaked milk can stain clothing. Also avoid any kind of non-breathable plastic lining in bra pads or bras.
- Sore and cracked nipples
There is always a reason for sore and cracked nipples. Seek help as soon as possible to solve the problem. If the pain is extreme you might have to temporarily interrupt breastfeeding. During such a break, it is important to continue to express your milk to avoid engorgement and to keep up your milk production. Your lactation consultant can inform you about pumping with a breast pump, hand expression, and alternative methods for feeding your baby during this time. To support the healing process, you can apply nipple cream or lanolin once the breastmilk you spread over your nipples and areolae has dried. Nipple shields can also help protect sore nipples when breastfeeding.
Breastfeeding should not hurt. If you experience breast problems, nipple pain or soreness, speak to your doctor, clinic sister or lactation consultant.