Engorgement can cause a nipple to appear flat or inverted making it more difficult for a baby to latch.¹ Once milk is expressed and the breast is softened, the nipple will protrude and your baby will be able to latch to your breast to feed. Some newborns have difficulties latching to the breast due to medical interventions or health-related conditions and will need continued monitoring by a lactation consultant to learn to breastfeed. 

What Can Help?

Reverse Pressure Softening

Engorgement will swell the breast and flatten the nipple making it difficult for a baby to latch to the breast.¹ A flat nipple lays at the same level as the areola and does not protrude outwards with stimulation. An inverted nipple collapses inside the breast with or without stimulation. Inverted, retracted, or flat nipples are normal variations of nipple shape and are likely present since birth. Most mothers with flat or inverted nipples will experience their nipples naturally draw out with breastfeeding.² To help soften the breast, apply a warm cloth and gently massage your breasts for a few minutes before breastfeeding. It’s crucial during this time to nurse frequently. Offer the breast often and use Reverse Pressure Softening, a technique that moves swelling upward and into the breast, providing relief from engorgement. To do Reverse Pressure Softening, place two fingers on the areola and apply gentle pressure inward towards the chest wall for 45-50 seconds. Move your fingers around the areola using the same technique to erect the nipple past the areola. Gently massage the entire breast in a soft circular motion and repeat.³

Hand Expression

Using your hands to express breast milk can protrude a flat or inverted nipple. Combine hand expression with gravity for a simple and efficient way to draw out the nipple. Gravity will aid in allowing the breast milk to flow naturally stimulating the nipple. Place a large bowl or basin on a flat surface and use hand expression to massage and express your breast milk into a clean container. Many mothers use this technique in the early days postpartum before breastfeeding to make latching easier for the baby.⁴

Nipple Shields

A nipple shield can be a temporary tool to improve breastfeeding at the breast and help you gain confidence to continue on your breastfeeding journey.⁵ To find the correct size for your nipple shield, measure your nipple diameter before pumping or breastfeeding and find a nipple shield that is closest to your nipple diameter. The shield should fit securely over the nipple and areola. When a baby is latched and actively breastfeeding, there should be visible movement on and around the breast. Breast milk on the tip of the nipple shield is another sign it is the correct size and being used properly. Nipple shields should be used with discretion and under the supervision of an International Board Certified Lactation Consultant.

Breast Pumping

What If I Have Questions?

If you are interested in learning more, these Aeroflow classes expand on some of the topics discussed above:

• Ultimate Breastfeeding Prep 
• Lactation Q&A

Want More Info?

For a directory of Aeroflow’s other Care Guides offering information on pregnancy, baby care, and more, browse our comprehensive list of titles:

References