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!