Hasmik Erdoglian, IBCLC at CHA Hollywood Presbyterian Medical Center shares valuable insights to address common questions mothers may have regarding inverted nipples and breastfeeding.

How would you define or describe inverted nipples and how do you know if you have them?
The breast development becomes noticeable during the fetus stage at 5 weeks of life. Towards the end of gestation, the ducts form openings in the nipples that are depressed below the surface of the skin. Just before birth, the nipples push outward and become level with the skin.

In some cases, this step fails, resulting in partially or completely inverted nipples. Inverted nipples pull inward rather than protrude when the mother’s areola is compressed.

Women, themselves, can determine whether one or both nipples are inverted by doing what some call a “pinch test.” Gently compress the areola about an inch (2.5 cm) behind the base of the nipple. If nipple protrudes, it is not inverted (even if it appears inverted at rest). If the nipple pulls in or becomes concave, it is a true inverted nipple.

Do inverted nipples make breastfeeding challenging? If so, how?
There are different degrees of nipple inversion, different types, and various explanations for their cause. However, it can make a difference at the gestational age, in general medical stability, and the labor itself.

Inverted nipples should not be considered a breastfeeding challenge. It can be a difficulty or inconvenience that can be overcome by the help of lactation consultants. In order to help newborns have successful breastfeeding sessions, babies need to latch deeper, on the areola, not on the nipple. A shallow latch could lead to breastfeeding failure and/or challenges such as, severe nipple pain for the mom and an unhappy baby. It’s shallow latch that is the challenge, not the nipple description.

Can you share some specific strategies for dealing with inverted nipples?
Any treatment to draw out flat and inverted nipples during or after pregnancy, is not recommended. Treating inverted nipples may cause more problems than it solves.

Expecting moms should consider prenatal breastfeeding classes, which CHA Hollywood Presbyterian Medical Center offers free of charge in English and Spanish. These classes can inform and educate expecting mothers, in order to make informed feeding choices.

If mom and baby are stable during their recovery and hospital stay, they can request hands on help by professional lactation experts, IBCLC.

If latching is difficult, the lactation consultant could offer a “hand expression” technique, which helps to provide breast milk, by using alternative feeding methods, such as: cups, spoons, or 3ml syringes.
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