Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
Inverted Nipples
Some women have flat or inverted nipples which may reduce their confidence in their ability to
breastfeed and cause some babies frustration when they are starting to breastfeed. There is no
reason why women with inverted nipples cannot breastfeed. Antenatal treatment may not
always be helpful. Assisting women with inverted nipples is most important soon after birth,
when the baby starts breastfeeding.
Management of flat and inverted nipples
• Build the mother's confidence.
o Explain that it may be difficult at the beginning, but with patience and persistence she
can succeed. Explain that her breasts will improve and become softer in the week or
two after delivery. Her baby's suckling will help to pull her nipples out.
o Explain that a baby suckles from the breast not from the nipple.
o Her baby needs to take a large mouthful of breast. Explain also that as her baby
breastfeeds, he/she will pull the breast and nipple out.
• Encourage her to give plenty of skin-to-skin contact and to let her baby explore her
breasts. Let him/her try to attach to the breast on his/her own, whenever he/she is
interested. Some babies learn best by themselves.
• Help her to position her baby.
o If a baby does not attach well by himself/herself, help the mother to position the baby
so that he/she can attach better. Give her this help early, in the first day, before her
breast milk “comes in” and her breasts are full.
o Help her to try different positions to hold her baby. Sometimes putting a baby to the
breast in a different position makes it easier for him/her to attach. For example, some
mothers find that the underarm position is helpful (see Figure 11.1).
• Help her to make her nipple stand out more before a feed. Sometimes making the nipple
stand out before a feed helps a baby to attach. Stimulating her nipple may be all that a
mother needs to do. Or she can use a hand breast pump or a syringe to pull her nipple
out (see Figure 11.2).
• Express her milk and feed it to her baby with a cup. Expressing milk helps to keep
breasts soft so that it is easier for the baby to attach to the breast, and it helps to keep
up the supply of breast milk.
• She should not use a bottle because that makes it more difficult for her baby to take her
breast.
• Express a little milk directly into her baby's mouth; some mothers find that this is helpful.
The baby gets some milk straight away so he/she is less frustrated, and he/she may be
more willing to try to suckle.
Integrated maternal and newborn care
Basic skills course
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