As the Breastfeeding Week is going on, well, literally coming to an end, there is something I wanted to talk about. A phenomenon called Flat Nipple. Have you heard about it? Have you struggled with it? I have, and I want to bring it out on the table, and start a discussion around it. When I faced this, I did not even know it has a name. I found this name only recently, when I am no longer a breastfeeding mama since more than three years now. Not being aware about it leads to a stigma which a new mother faces, of not being capable enough to feed her child, to be unable to breastfeed, which is the most natural thing ever!
First up, what is a flat nipple? According to Babycenter.com ‘Flat nipples don’t stand out much from the surrounding area (called the areola) and don’t protrude when stimulated. That sometimes can make it difficult for your baby to latch on and breastfeed.‘ Then there is an Inverted Nipple too, which pull inward when stimulated.
In such cases, as stated, the baby is unable to latch on. It is a fact, that here in India, social taboos rule even the relationship of doctors and their patients. Even highly qualified doctors fail to inform their patients about such phenomena, which leads to confusion, and half informed decisions later on. I don’t think most women are even checked for flat or inverted nipples. This ignorant practice is just a part of many more such practices, like episiotomy i.e. artificially widening the vaginal opening during delivery by incision, or like taking away the child after birth and feeding her formula without trying for breast feed, or even without taking permission from the parent(s). More on that later though.
When my daughter was born at 7:04 in the evening, though born through a vaginal delivery, was taken to the NICU, as she had to be given oxygen. I just caught a small glimpse of her before she was ferried away. I was shifted back to my room, where I had dinner. At around 8:30pm, a little bundle was carried in the room and handed to me. There she was, all swollen, but still the tiniest baby! She was surprisingly squeaky clean! I was fearing a head full of white flakes, but there she was, all prim and propah’! She was not hungry though. She had been fed formula. Without my knowledge, though I was not in a situation to think about it at that moment. I thought it was normal. After some time, maybe an hour, the nurse came in when the little one started crying. She tried to help me let the baby latch on and we tried a lot. In the end, the little one was crying at the top of her voice, and I was getting tired. She could not latch. I saw, that my nipple had no shape of a nipple! So, the nurse squeezed some colostrum in a spoon, and fed the little one. She said, no matter what, this is very important. Then the doctor was informed and she said that my previous gynaecologist, to whom I went to for checkups during my pregnancy, had missed out on informing me about this, and had not told me any exercises to improve the shape of my nipples. She immediately told us to get a nipple shield, but alas, the only ones available nearby were very weird, of the shape of a bottle nipple. I was clueless. I struggled all night, my mother helped me, and by morning I was able to feed her a little, mind you, it was only a little. My experience with that nipple shield was not very good. So, I searched online, and found a better looking nipple shield (click to view). This one, made of good quality silicon proved to be the best aid. It took the shape of the breast, felt natural, was painless, and eventually help rectify the flat nipple. It was only after four months that I was able to feed my child without the help of any aid.
Here is what I learnt:
- Flat Nipple/Inverted Nipple is not uncommon. Many women face one or the other issue in the beginning.
- There is not much discussion around it. Many gynaecologists, despite having decades of experience behind them, do not discuss this possibility with the expecting mothers. They refrain from checking the expecting mothers for this too.
- There are very few good quality breast feeding aids available in the market. Breastfeed aids, for such problems, are either not available, or are very crude or basic, which are not up to the mark.
- Online portals have a decent number of options to chose from. More than the retail stores, it is the online portals which are of help.
- Flat nipple can be due to engorgement of breasts also. It is very much possible the engorgement has led to swelling of the areolar area, and hence the non formation of the nippular shape. This can be easily solved by expressing some milk and lightening up the breast.
Here is what helps:
- Breast Shell: This is made of a harder material, as compared to Nipple Shield. It is supposed to be worn between feeds. It is not supposed to be worn during the feeding. It can be worn under the bra. It basically helps in squeezing out the flat/inverted nipple out, and help create a nipple which the baby can latch on to. Also, it contains a shell which can collect any milk which drips out during the process. But a word of caution here, the milk collected is not supposed to be given to the child as it is not fresh and has full chances of catching mould. A few brands which Breast Shells available here in India are Farlin, Philips Avent, and Medela. You can check these out by clicking.
- Breast Shield: A good Nipple Shield is made of very soft silicone. It feels like a thin membrane, which has a protrusion like a nipple, with pores in it to assist the flow of milk into the baby’s mouth, just like a natural nipple. Because it is thin, it takes the natural shape of the area around the breast and the baby experiences more or less a natural nipple while suckling. Also, nipple shields give the chance to the baby to help the mother. When the baby suckles through a nipple shield, the breast tissues slowly form a naturally shaped nipple. It may take some time, but it helps. I fed my daughter using a nipple shield and was successful in naturally feeding her after four months. Just make sure you buy a good quality one from trusted brands like Pigeon, Morisons, Medela, Chicco etc.
- Breast Pump: Breast pumps are of a great help to lactating mothers who are not able to feed their babies due to many reasons. Till the time mother and child duo figure out a way to feed, pumping the breast milk and feeding the baby through a bottle is a better option than giving the baby formula. Also, pumping helps stimulate the nipple and help in the proper shape formation. These are available in plenty, hence I am not giving any suggestions.
- Evaluation by the doctor or lactation consultant: The best opinion, suggestions, and techniques can be told by them. Everything else can help, and work most of the times, but if it doesn’t please fight your inhibitions and talk to your doctor/lactation consultant. Breast milk is very important for your child. It is meant to be that way, let us conquer the problems if there are any.
My daughter was fed both Breast Milk, and Formula in the beginning. I had to make her accustomed to top feed, as I had to join work after three months. But, I chose not to give her formula after two months and a half, and replaced the little formula she was having with cow’s milk. I can say this that she took it very well, and we faced no problem. Hence, I was able to avoid formula after that at all!
Let us make the world a better place where breast feeding is important and the aids to help in the process are easily available. This is possible only if we share the information and knowledge.
Let’s build a strong community!