Q. My baby is due in a month, and I'm very eager to breastfeed. However, my nipples are flat, which I've heard can make latch-on more difficult. Do you have any suggestions that will help my baby breastfeed successfully?
A. While protuberant nipples can make grasping the breast easier for a baby, an infant can certainly learn to nurse effectively from flat, and even inverted, nipples. Try the following latch-on technique for nursing using the traditional cradle hold: Support your baby using your arm on the same side you will be breastfeeding. Her head should be resting in the crook of your elbow or on your forearm. Rotate your arm to turn your baby's whole body toward you, so the two of you are chest-to-chest. During the learning period, it is important that you support your breast using your opposite hand to help your baby stay well attached. Cup your four fingers under your breast, placing your index finger and thumb parallel to your baby's jaws and well behind the margin of your areola, the dark circular area surrounding your nipple. Your baby needs to grasp the entire nipple, plus at least one inch of surrounding areola and breast so her jaws are situated over your milk ducts.
With your baby turned toward you, lightly stroke the midpoint of her lips against your nipple until she opens her mouth widely, as if yawning, and then quickly pull her onto your breast. When she is latched on correctly, her mouth will be wide open with her lips flared out (a bit like a fish), her nose resting against your upper breast, and her chin against the underside of your breast. She will not grasp sufficient breast tissue if you try to push your nipple into her mouth or attempt to attach her when her mouth is only slightly open.
Some health-care providers recommend the use of breast shells, also known as milk cups, for women with flat or inverted nipples. These hard, plastic, dome-shaped devices can help make the nipple more protuberant by directing it forward through a central opening in the shell. This opening is situated over your nipple, and the device is held in place by a maternity bra during the last month or two of pregnancy. (Breast shells can also be worn between feedings after the baby is born.) Another strategy for making a flat or inverted nipple easier to grasp is to use a breast pump to draw it out before you feed your infant.
Don't be afraid to ask for help if you're having difficulty. Ideally, your first breastfeeding session will occur within 30 to 60 minutes after giving birth, when your baby's sucking instinct is most intense and help from a knowledgeable lactation consultant or nurse is readily available.
Contributing editor Marianne Neifert, M.D., is co-founder and medical consultant to the HealthOne Lactation Program in Denver, Colorado, and author of Dr. Mom's Guide to Breastfeeding.