Why are my nipples stretchy?

Breastfeeding a newborn

Elastic nipples during breastfeeding

If you’re breastfeeding you’ve probably noticed that your nipples have taken on a new super-elastic property. This will be especially obvious when your baby does a sudden detach from the breast, or when they decide to have a look around with your nipple still in their mouth, leaving you wincing but also wondering if you missed a career opportunity as a contortionist. Something about the sound of milk being frothed in a cafe is guaranteed to turn Mr J’s head: cue Stretch Armstrong nipple and public boob exposure.

The science bit

Protractile (stretchy) nipples are caused by hormonal changes that start during pregnancy and continue during breastfeeding to promote skin elasticity. Around 1 in 10 pregnant women have flat, inverted or non-protractile (less stretchy) nipples. Because none of us are perfectly symmetrical, including our breasts, this may affect one or both sides.

For over 50 years in the UK, and elsewhere, it was common practice to assess pregnant women’s nipples. Women with anticipated problems were advised to “prepare” their breasts by one of two methods. Either wearing breast shells (a kind of dome that fits over the nipple and part of the breast and is worn inside the bra to gradually stretch and elongate the nipple), or doing Hoffman’s exercises, which involve stretching the nipples with your fingers and thumb . This practice was based on little evidence, and often had the unfortunate effect of undermining a woman’s confidence in her ability to breastfeed before she had even started. A study conducted in Southampton in the late ’80s found that using shells actually lowered breastfeeding success rates, and the nipple stretching exercises had no effect.

Some mums might doubt their ability to feed because of the way one or both nipples look. However, a visual assessment in pregnancy doesn’t really give much information away, as nipples can appear flat or inverted but actually protrude when the baby starts feeding. In fact, NICE (National Institute for Health and Care Excellence; the body who decide which treatments and drugs should be offered to patients through the NHS) state in their antenatal guidelines that routine breast examination to promote breastfeeding is not recommended. The best test is how well the baby latches and feeds once they arrive. Remember that babies don’t nipple-feed, they breastfeed. The nipple plus breast tissue are drawn into the shape of a teat in the baby’s mouth, and nipple elasticity helps with this.

What if I think my nipples aren’t stretchy enough?

La Leche League GB has some really practical advice on feeding with inverted nipples. Nipple elasticity often improves over time as the baby latches and sucks over successive feeds. However, when feeding isn’t going well in the early days it can be really disheartening, not to mention painful. My advice would be to attend a breastfeeding clinic (these are usually found at hospitals or children’s centres – a midwife or health visitor should be able to tell you about your local one) or, better still, arrange for a lactation consultant to visit you. The IBCLC website is the best place to look, as all of the consultants listed are professionally qualified. They will sit with you while you feed and offer one-on-one advice. Every breastfeeding partnership is unique to mum and baby, so this practical support can make all the difference.

I had a lactation consultant visit me at home when Mr J was a few days old as I was struggling with latching and positioning. Actually, struggling is an understatement. I couldn’t get him to open his mouth wide enough, and when he did I was too slow and unsure to actually get him on the breast. I was so stressed about it that I was gripping his poor little neck, which meant he couldn’t tilt his head back to get a deep enough latch, and oh how it hurt.  If I hadn’t had that support early on, it could have spelt the end of our breastfeeding journey.

Some consultants work on a voluntary basis, others charge a nominal fee. I paid £50, but the consultant stayed with us for over 2 hours and followed up with phone calls and texts over the next few weeks to see how I was getting on. She gave me confidence, and it was worth every penny!

M&S breastfeeding friendly swimsuit review

Zip front M&S swimsuit

Swimwear you can breastfeed in

This morning’s swimming class was a chance to try out my new Marks & Spencer swimsuit. The zip is functional, so it’s a doddle to breastfeed in and it has built in tummy control so it’s a bit more flattering. I love the print and it definitely screams summer.

Zip front M&S swimming costume

It’s pretty reasonably priced at £29.50 and comes in sizes 8 – 22 (I’m wearing a size 8 here and I’d say it’s pretty true to size). The fabric is soft and stretchy so it feels comfortable, with no annoying bits digging in! Mr J is wearing a John Lewis SunPro swimsuit with built in UV protection.

I ordered online and collected in store as it drives me nuts when my size isn’t available. So get ordering mamas. Perfect for feeding by the pool or on the beach!

Normalize breastfeeding

What drugs can I take while breastfeeding?

How to check what medicines are safe to use while breastfeeding

How many of us suffered through colds and hayfever while pregnant with only feeble hot lemon and honey drinks for relief? Oh, how I longed for decongestants and antihistamines! If you were to read Patient Information Leaflets (“PILs”, aka the little bits of white paper inside medicine boxes), you’d be forgiven for thinking the situation with taking medicines while breastfeeding isn’t much better.  However, the wonderful people over at the Breastfeeding Network have compiled a number of fact sheets summarising the available safety information on a whole range of different types of prescription and over-the-counter drugs so that breastfeeding mums can make informed choices about what they take. They also run a Facebook page and email information service in case a drug you wish to take isn’t covered in their factsheets, or if you just need a bit more advice.

The science bit

So why do drug manufacturers recommend against the use of so many medicines while breastfeeding? The answer is simply lack of conclusive evidence. Virtually all clinical trials exclude pregnant or breastfeeding women because of the ethical and legal implications if something were to go wrong. If you asked a pharmacist or GP if a medicine was ok to take while breastfeeding, they’d probably recommend against many of them because the textbook they refer to (the British National Formulary or BNF) usually provides little guidance. However, there is often additional information available from pharmacokinetic and pharmacodynamic studies, which can tell us how much of a drug passes through to the mother’s milk, for example. Small trials and case reports of breastfeeding women who’ve taken medicines sometimes also add to the body of evidence.

So how do I know which drugs are safe?

Your GP should always be your first port of call for any prescription medicines. However, if they are recommending against you taking something that you feel you really need, it’s worth checking the Breastfeeding Network’s information sheets. Print one off and take it to the GP with you if necessary. They cover everything from antidepressants to migraine medication.

For over-the-counter medicines, it is definitely worth checking the factsheets before completely discounting taking something. For example, I am currently suffering with hayfever (and also breastfeeding), but all the available over-the-counter medicines are not recommended by the manufacturer. However, when I checked the relevant information sheet from the Breastfeeding Network I can see that certain types of hayfever tablets reach low levels in milk and therefore should be ok for me to take.  This is, of course, my decision based on what I have read, and what I feel are the relative risks of taking the medicine versus the benefits of me getting some relief!

Needing to take medication should never be a barrier to you continuing your breastfeeding journey. So arm yourself with knowledge and make the decision that’s right for you. Good luck mamas!