Breastfeeding Questions: Larger Breasts and Inverted Nipples

Tips for Breastfeeding with Larger Breasts

Lisa mentioned that she has large breasts and an inverted nipple, which made it really hard for her baby to attach and feed correctly at first.

There are a couple of reasons this could have been difficult initially. First, Lisa’s baby girl was born at 37 weeks gestation. This is still considered “term” but some babies who are born closer to 37 or 38 weeks of pregnancy may be sleepy at first and are more likely to not feed as frequently and get jaundice.

All of this makes breastfeeding hard work as it is really important that if your baby is not able to fully breastfeed (i.e. eight times in 24 hours) that you make up the difference by expressing your milk.

This is important as initiating your milk supply well in the first few days plays a role in how much milk you will later be able to produce. Babies who are likely to be sleepy in the first 48 hours after birth are:

• Those born by caesarean section
• Babies and mothers who have laboured with an epidural or opiate medicines
• Babies born under 37 weeks of gestation
• Some babies who have been born through a very quick labour

There may be other reasons your baby is sleepy but what’s important to remember is that if your baby is not feeding frequently you will need to express until baby wakes up hungry and can do it for themselves!

Secondly, feeding with large breasts can take some time to feel comfortable and confident, have a look at our blog on breastfeeding with larger breasts to find some more helpful tips.

Breastfeeding with an Inverted Nipple

Lisa also mentioned that she had an inverted nipple. There are different types of inverted nipples; some which pop out (evert) when they are cold or stimulated and some which are called "true inverted nipples," which means they never pop out (evert).

Many women have inverted nipples and it is not something to hide or be overly worried about, it’s just a variation of normal.

When it comes to breastfeeding, it is a good idea to mention it to your midwife so you can discuss a feeding plan specific to you. Many women can breastfeed perfectly well with inverted nipples and just need to draw out their nipple with stimulation, cold compresses or the suction from a pump before feeding. Some women find that shaping their breast can also help baby attach well.

Your midwife will show you how to do this before feeds. Some mums though may need to use a nipple shield to help their baby attach. Your midwife will be able to see what works best for you and your baby.

Over time and lots of breastfeeds, many babies evert the mum’s nipple. For some mums this stays everted into their next pregnancy, like Lisa’s has.

Understanding Nipple Shields

Lisa needed to use the nipple shield to initially help her baby to feed, but, after a few weeks of use, she found that her baby was able to attach to the breast without the shield. This is how most women use the nipple shields; as a tool, to help them get to full breastfeeding.

There will always be some women who need to use a nipple shield for their entire breastfeeding experience. This is also ok. It’s about using the nipple shield to help support breastfeeding in a way that works best for you and your baby.

Below I’ve listed some of the feeding plan Lisa and I discussed for the first few days after birth:

First, ask for the midwives to dry baby after birth but not their hands. This leaves the amniotic fluid on their hands which smells and tastes similar to your colostrum and helps baby find their way to the breast after birth and self-attach.

Aim for immediate skin to skin contact and leave baby there for at least an hour, if not longer (if all is going well). Ask to have baby weighed after the first breastfeed. Ask to transfer to the postnatal ward still in skin to skin contact (where possible – check with your midwife first).

Try and breastfeed in the first hour. If your baby is not ready to breastfeed yet then express. We would advise a combination of hand expression and pump use if baby has not shown interest to breastfeed themselves.

If baby had a good breastfeed in the first hour, then enjoy your sleep for about another six hours! Remember this may be the last long period of sleep baby has for a very long while!

Once six hours has ticked by baby will probably wake up to feed by themselves. If baby is not yet interested in feeding place baby in skin to skin contact again and try and feed baby, they will show you signs when they are ready. Wait up to two hours, but if baby is still not ready to breastfeed, start expressing. Continue to use a combination of hand and pump expression. Express about 8 times in 24 hours until your baby is breastfeeding.

Normal baby behaviour in the first few days whilst there is colostrum in your breast is for babies to breastfeed VERY frequently. This is super normal and nothing to be concerned about. They are sending frequent signals to your breast and brain to help bring in your milk and ensure you have a good milk supply further down the track.

Babies will need to feed a minimum of 8 times in 24 hours but may feed many more times during these first few days. Try and get as much rest as you can in between.

For more information and support join us at Medela Australia Facebook or visit the Medela NZ Facebook page.

Do you have any breastfeeding questions that you would like Katie to answer? Please leave them in the comments section below.