tips for breastfeeding / chestfeeding with inverted or flat nipples
By Kimberleigh Weiss-Lewit, IBCLC
Many new parents worry that their nipples are not adequate for nursing their new babies. While breastfeeding/chestfeeding with flat and inverted nipples can be more difficult, especially if your baby also has challenges achieving a deep latch, nipple size and shape may be less of a concern than a parent may have anticipated. With ideal latch and positioning support, many people can nurse their babies just fine, despite non-protruding nipples. It might be reassuring to remember that babies latch onto the areola, not just the nipple and that they can even “pull” an inverted nipple out with good sucking.
Knowing what to expect and what can help if you run into challenges can set you up for successful nursing. Most importantly, new nursing parents should have easy access to an International Board Certified Lactation Consultant (IBCLC) whenever challenges arise. Your IBCLC can help assess, assist, and create a plan for you and your baby’s unique needs.
Here are several considerations and tricks to address nursing issues arising from inverted or flat nipples:
1. A deep latch and close positioning can make a big difference!
Good positioning, especially for newborns, is always important but becomes even more important for a nursing parent with an inverted nipple. Aim to bring your baby to the breast/chest chin first and slightly below your nipple. Be sure baby is facing you completely in any position and is as close to your body as possible (skin-to-skin gets you even closer!). The “flipple” is a great technique to achieve a deep latch and the nursing parent can use their hand to shape and guide the nipple to the roof of their baby’s mouth stimulating their babies sucking reflex. Laid or leaned back positioning are usually excellent for newborns and encourage them to instinctively latch deeply!
2. Utilize tools to help make your breastfeeding or chestfeeding experience easier
Modern parents have no lack of nursing products and gadgets available to them and several tools can be especially helpful for the parent with a flat or inverted nipple! Pumping with an electric or hand pump can draw an inverted nipple out. You can use your pump for a few minutes right before trying to latch your baby and you may also notice that pump use (and nursing) over time help your nipples to stay everted.
Several companies even make specific tools for the purpose of encouraging inverted nipples to come out including the Lansinoh Latch Assist, the Haakaa Inverted Nipple Corrector, and Supple Cups. These are often designed to be used right before latching— like a pump—but with much less set-up. Nipple shells can be used between nursing sessions to support your nipples in protruding out more. Shells have the added benefit of protecting your nipples from rubbing on your bra or clothing if they are sore or damaged.
Nipple shields, a silicone nursing accessory you place on your breast to effectively create a more protruding nipple, can be very useful when you are finding that your nipples are not protruding at all and your baby is having a difficult time achieving or sustaining a latch. Babies seek stimulation at the roof of their mouth that elicits the sucking reflex and in some cases the nipple will not reach that point of their mouth, causing them to unlatch. This is more common when babies are very young/born prematurely, have tightness in their jaw or have restricted oral tissue (tongue-tie). Nipple shields (see proper use video here) should be used under the care of an IBCLC and ideally for a limited amount of time.
3. Engorgement can create more challenges, luckily it is temporary
Even if your little one happily latches and is nursing during the first few days of life, you may experience latching a challenge if you develop initial engorgement. Many nursing parents find that as their milk transitions (often days 3-5) they struggle with breast/chest swelling that can make their areola firm and reduce the protrusion of the nipple. This can present a problem for any nursing couple but can be especially problematic when the parent has flat or inverted nipples. In addition to using a little hand expression or pumping to release pressure and soften the areola before nursing, a simple technique called “reverse pressure softening” is often quite effective. The nursing parent simply presses back on their areola to move some of the fluid or swelling back into the breast and to create a softer base for their baby to latch on to. Initial engorgement, if you get it, usually lasts 24-48 hours, and most times latching is easier for you and your baby after this phase. If you are experiencing engorgement, this is an excellent time to work with an IBCLC and be sure you are doing everything to keep your milk flowing and your baby nourished.
4. Care for sore nipples
Anytime a nursing parent has nipple pain or damage it is a good idea to connect with a lactation consultant. We can figure out why you are in pain and offer targeted suggestions to help you feel better quickly. Breastfeeding or chestfeeding parents with flat or inverted nipples might be at a higher risk for experiencing nipple damage simply because getting your nipple deep in your baby’s mouth is what protects you from discomfort and these nipples may be harder to get into baby’s mouth as deeply. In addition to focusing on deep latch techniques, using hydrogel pads and saline rinses (especially if nipples are cracked or bleeding) can speed up healing between nursing sessions. For a saline rinse or nipple bath, mix ½ teaspoon of salt in a cup of warm water. Rinse or bathe nipples for a couple of minutes several times a day to minimize the risk of infection and promote healing. Hydrogel pads can be worn between nursing sessions and provide soothing relief.
While nursing your baby is a natural experience, it may not come easily at first. Getting support early and often can make a world of difference. IBCLCs are skilled at working with both the nursing parent and their baby to find a way for them to have a comfortable and satisfying nursing journey—please don’t let anyone tell you breastfeeding / chestfeeding with inverted or flat nipples won’t be possible for you —we can help!