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Expert Q&A

	By Melissa Clark Vickers International Board Certified Lactation Consultant Moms & Babies Huntingdon, Tenn.

Where can I find breast shells? Do they help with flat nipples? I'm pregnant with my second child and will breast feed if it kills me. I gave up too soon with my first and introduced a bottle because it was much easier for him to latch on to than my flat nipples. I am very regretful for this although he is a happy healthy 14 month old now.

Nipples come in all different sizes and shapes--some more conducive to breastfeeding than others. The good news, though, is that your baby has NO experience with ANY nipples when he's born, and thus doesn't enter the world with expectations as to how nipples are ""supposed"" to look.

And, because babies BREASTfeed rather than NIPPLEfeed, and because the nipple is little more than a bunch of tiny straws, it is usually possible to get baby happily--and effectively--latched on to just about anything.

The inside of babies' mouths can vary as much as the shape and size of the nipple, as can their readiness to breastfeed. Often medications during labor and delivery can make it more difficult for a baby to organize himself to the task of breastfeeding, and his sucking response may need a little extra help. These babies do better with nipples that more closely match the insides of their mouths.

As for what you can do to help nipples that are flat:

1. Learn all you can about breastfeeding and positioning at the breast. Attend classes and/or La Leche League meetings in your area.

2. Try to begin nursing as soon after delivery as possible, and ask that your baby not be given ANY other nipples--be it bottles or pacifiers--so he won't expect a nipple to be shaped hard and long. Nurse as often as you can before your mature milk comes in.

3. See if cold makes your nipples stand out more. Sometimes using ice or a cold cloth right before nursing helps those nipples stand out.

4. Use a pump right before latching your baby on. The suction will help pull the nipple out, and once baby latches on, he'll do the rest.

5. Once your mature milk comes in (usually 3-5 days after delivery), you may find that your nipples and breasts are so full that your nipples appear to be flatter than they normally are. If this is the case, use a pump or hand express enough milk to soften the nipple and areola (the dark area around the nipple) enough for baby to latch on.

6. There are breast shells that put gentle pressure on the nipple tissue to help bring them out that can be worn in the last weeks of pregnancy and then between feedings once your baby arrives. Medela, Inc. sells these.

7. If your nipples are very flat, even after trying all these tricks, then getting help from an International Board Certified Lactation Consultant (one with IBCLC after her/his name) is the best way to go. These folks are specially trained to work with this kind of situation and they can help you with positioning, and even other ""tricks of the trade"" to overcome flat nipples.

Hope this helps!"

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