Flat or Inverted Nipples
A flat nipple is one that, when the areola is compressed about an inch behind the nipple, flattens out and appears level with the surround areola or becomes thick and barely protrudes past the surface. An inverted nipple pulls behind the surface of the areola and may pull inward into the breast.
Prenatally: Try Supple cups starting at least 8 weeks before delivery. Check outfor product information. Begin using these as per instructions. Consider purchasing softshells for inverted nipples to wear over the supple cups to allow longer periods of wearing to help correct the condition prior to delivery.
After Delivery: Try Latch Assistant by Lansinoh. This can be used on the nipple itself or placed over a nipple shield (if needed) to draw the nipple out or to pull inside the shield before latching.
Supple cups can also to be used in the same way.
History of Latch difficulties with delayed or slow onset of Stage 2 of lactogenesis.
- Initiate breastfeeding within the first hour after delivery with mom in laid-back position, using biological nurturing approach. See: http://hopebreastfeedingsupport.com/the-first-100-hours-getting-breastfeeding-off-the-ground/ for more basic tips. If areola is tight (feels like your chin or the end of your nose), use reverse pressure softening and areolar expression to increase nipple availability before baby latches. See: http://hopebreastfeedingsupport.com/video-resources/. Once baby has latched, remain reclined throughout the feeding. Switch breasts when baby starts to pause a lot (usually every 5 minutes or so). At 24 hours, begin softening and expression before every feed, even if you don’t think your areola is firm.
- Ask for a hospital breast pump to be brought to you right away, along with syringes for milk collection. If your baby is not latching well by 12 hours, begin using breast pump in addition to hand-expressing.
- Offer the breast every 2 hours until 10:00 at night, and then every 3 hours during the night. If baby is too sleepy to latch, hand express about 10 minutes and then pump for 15 minutes. Give any colostrum to the baby by finger-feeding. This is for first 3 days of life.
- If your baby cannot latch to the breast or stops latching, ask for a small and a large nipple shield. Try both to see if baby can latch to either. Ask for demonstration from your care provider. If you have not started pumping yet, begin doing so. Pumping in the first 3 days should be about 15 minutes using the Symphony initiation program. Once your milk starts coming in, use the maintenance program and move the vacuum up to about 10 bars on the screen. Ask for written instructions for pump use. Plan on taking a rental pump home from hospital if needed. Remember milk does not start squirting until Day 7 after delivery.
- Check baby’s suck using your thumb to see if baby is drawing your thumb back to the back of her tongue or is only “peanut butter sucking” on the tip of your thumb. Sometimes a little suck training before latch can correct what is just a habit baby has at birth.
- If no comfortable latch, strong latch is obtained, plan to see a lactation consultant around 4th-5th day (optimal time when milk has come in and baby is more alert).
- Monitor baby’s weight loss. If mom’s milk is not coming in quickly, have donor milk or ready to feed formula available for early supplementation as needed. Many organizations recommend hydrolyzed formula if human milk is not available. If supplementation is needed in the hospital after the first day, ask for oral syringes and a feeding tube for easier finger feeding or at breast supplementation. If long-term supplementation is required, a Dr. Brown’s bottle and side-lying baby-led bottlefeeding technique can be used. See information and videos http://hopebreastfeedingsupport.com/video-resources/.
Breastfeeding Assistive Devices
(available from, and )
- Latchassist by Lansinoh
- Hydrogels by Medela (2 pkgs)
- Nipple shields 20 and 24 (if not obtained from hospital)
- Medela Harmony manual pump
- Haaka milk collector
- Tube top – makes a comfortable holder for nursing pads, can be used as a pumping bra
- Dr. Brown’s 4 oz regular newborn bottle (not glass, not wide mouth)
- Microwave sterilizer bag (if you have a microwave)
- Oral syringes
- Pump kit
- Rental pump
- Feeding tube (used for finger-feeding or at breast supplementation)