Okay ladies, take your top off and have a close look. Is the areola pink or brown, smaller than a 50 cent coin or as large as a coaster? Are the nipples long, short, wide, flat or inverted?
“Everyone is different and it’s generally not something to be overly concerned about, but it can be really interesting and useful to have a good look at your breasts and notice what direction they point in,” says Jessica Leonard from the Australian Breastfeeding Association.
Pay attention when you see other mums breastfeed or watch videos online, and remember that you will need to work with your own anatomy – if you see a mum with small, high breasts attach her baby and you have large, droopy ones, chances are you’ll need to position your baby differently. Even accessories like breastfeeding pillows aren’t necessarily one-size-fits-all. You’ll need to consider the length of your torso, the height of your nipples when sitting down, and whether these match up with your bub’s mouth when lying him on the pillow. To help you know your nipples, here’s the lowdown of nipple wisdom from the breastfeeding experts.
Knowing that milk squirts out of the nipple tip, many mums just place bubs’ lips nearby and hope for the best. But latching your baby is a bit trickier than that. “Start by remembering it’s called breastfeeding, not nipple feeding,” says Jessica. “Baby needs to have a mouthful of areola and breast tissue, not just the nipple.
This means the nipple will go all the way to the back of bub’s palate, past the hard part of the roof of the mouth to the soft section at the back.” To do this, position your littlie in a chest to chest position with his chin touching the breast. When he opens, support your baby between his shoulder blades and give him a gentle push towards you, so his mouth levers up and over the nipple. Once attached, his top and bottom lips should flare outwards, like fish lips.
CRACKS AND GRAZES
Ouch! If the nipple rubs on baby’s hard palate, friction can cause grazes or cracks to form, which can be excruciatingly painful. To avoid this happening, lactation consultant Sue Nicholson suggests asking for help early. “I strongly advise attachment checks for the first 48 hours in hospital for every feed, with the first feed being so, so important,” she says. If you can, try to breastfeed without a pillow by placing bub on your chest for baby-led attachment, or recline slightly once you’ve latched to take the weight off your arms.
FLAT OR INVERTED NIPPLES
Of all the different nipple shapes, mums worry most when theirs are flat or inverted. “For most mums who have an inverted nipple or two, gently massaging the nipple will encourage it to come out, and make attachment easier,” says Jessica.
Attaching to flat nipples can be challenging when your milk first comes in. “Engorgement can round breasts out and it becomes like trying to drink from a basketball,” says Jessica. Expressing some for comfort before attempting to attach can be helpful, as it softens the breast tissue surrounding the areola.
When attachment is too shallow, the nipple can be squashed in baby’s mouth. This will be obvious when you can see a white line or ridge on the nipple when bub releases his latch. “It’s important to recognise when a baby slips off the nipple during the feed and to reattach,” says Sue, who focuses on teaching the mum to bring her baby towards the breast rather than bringing the breast to the baby.
If nipple pain doesn’t improve with positioning and attachment, there are various other issues to explore. Vasospasm “happens when the blood vessels in the nipple spasm and tighten and stop blood flowing into the nipple,” says Jessica. “Applying warmth to the area can make a big difference, as cold weather can worsen the condition.”
Another painful malady is nipple thrush, which is caused by the candida bug and can result in stinging, red, shiny nipples and a white coating on your little one’s tongue. “It can sometimes pop up after mum has been taking antibiotics,” adds Jessica. Your doctor can help you with treatment options for thrush, or help to diagnose other problems, such as bacterial infections like staph, or even dermatitis. In these situations, seeking the help of a health professional with a strong background in breastfeeding management is advised.
Breastmilk is anti-infective, anti-fungal and anti-microbial, so hand expressing a little bit to smear on the nipples after feeds before air-drying is the Australian Breastfeeding Association’s main advice (after seeking help with attachment, of course!). Sue also finds the use of lanolin ointment a handy solution. “It’s certainly helped a lot of mums,” she says.
Another commercially available product, which promotes moist wound healing, are compresses soaked in aloe vera. Many mums report that these soothe hot, stinging nipples, although Sue warns mamas not to overuse them as sometimes too much moisture can breed thrush or cause unpleasant rashes. It is advised to only pop these compresses in your bra for short stints, not leaving them there for the whole time between feeds.
A peek inside the cupboard of your local breastfeeding clinic will usually reveal boxes of breast pump flanges and nipple shields. When using a breast pump, you’ll need to measure the cone part to make sure it’s the right size for your nipple. “Pump flanges can be too small and cause a fissure at the base of the nipple,” says Sue, who says to be sure the flange sits comfortably and doesn’t misshape the nipple.
Nipple shields also come in various sizes. “I use 24mm as standard,” says Sue, who mainly uses them for flat and inverted nipples, or for bubs who won’t attach but will take a bottle. “I think shields do have a great place in helping establish feeding when there’s a problem,” she adds. See a lactation consultant for help weaning off shields, as bubs sometimes take a shine to them over the bare breast.