Is it possible for nipples to be too flat to breastfeed successfully?

[Pinkseren]

Would really appreciate some advice/pointers. My dd is almost 3 weeks old and we got off to a shaky start with breastfeeding whilst in hospital. I had a lot of support in getting her to latch and was told that I was experiencing difficulties because my nipples are flat. I persevered with breasfeeding because it was something I really wanted to do for my daughter, however left hospital with cracked nipples and within a few days ended up with weaping sore nipples and mastitis.
Since then, I have continued to try to breastfeed, however my dd rarely seems satisfied after a feed (she falls asleep at the breast and her latch weakens, but within a few minutes after coming off is still hungry) and I have been supplementing with formula. I experience pain following breasfeeding which lasts about 3 hours and stems from the nipple through by breast. At worst, I have pain which extends around my back.
I have been expressing in the hope of bypassing this, however still experience pain for the same length of time after expressing as I do after feeding. Also, I am finding that I am able to express about 100ml in the morning but am only able to express around 60ml on the other occasions that I express throughout the day. I have expressed three times today because the pain has been unbearable and am really on edge as I have just 'fed' her and again ahd to supplement with formula, and am dreading expressing in about an hours time, as I'm afraid that I won't be able to express enough.
So, in a nutshell, is it possible that the pain I am experiencing is purely down to the flat nipple, and do you have any solutions for me because I am feeling really down about this and feel at the end of my tether?

Dont have a technical answer I'm afraid, but wamted to post to say well done so far, and you are dping really well to persevere through the pain. Is it possible you have mastitis or something? Sorry not knowledgable enough,ut I also had a tough start with ds1 and was told by one one midwife that my nipples were too small, but once we got going properly, it didnt matter at all - bf ds1 and 2 for over 12 months each, so I would suspect there is some kind of infection. Have you a nice mw or bf counsellor you can conta t as I think the support is the most important bit to sprting out any bf problems.

Sorry just read that you already had mastitis. Didnt read properly the first time. Still think it sounds like an infection or positioning, rather than the nipples themselves.

Thank you for your reply. I did get treated for mastitis and the antibiotics ended last tuesday. I was in such pain and scared that because of possible infection, I should not be giving my daghter my milk, that I went to the out of hours GP and they said that there was no sign of the mastitis any more, nor of thrush (which I understand is also very painful). It is good to know that I might still be able to continue with this.

I would second the advice that you get a mw or counsellor to have a look. I had problems with my left nipple in the early days, I was advised to express a tiny amount from it before feeding DS to sort of "pull it out", which seemed to make it easier for him to latch on. Since then it's got a lot better by dint of breastfeeding, but I don't think I'll ever be able to hang my coat on it...

Good luck!

I was told by several less-than-helpful midwives that my problems feeding DS were down to flat nipples. I now think this was probably bollocks and he had am undiagnosed tongue tie.

I'm currently pregnant and my new midwife has told me that babies can feed from more or less any nipple (including inverted) and that there will be much more support etc in the county I now live in to help establish BFing 'properly' ( with DS i expressed full time for three months)

Using a pump does get your nipples sticking out quite effectively! There are also shields, little cup things to help etc. Ask for more support - don't rule it out. Local breastfeeding cafe / clinic / NCT or La leche league might be able to assist you.

PS expressing full time is irritating but not painful (once you are healed) and if you decide to go down this route I recommend a decent electric double pump, I used a Lactaline one which was excellent. You will be able to express more at different times of day - this is normal!

The thing about breast feeding is that it is not just about the nipple but the actual breast tissue as well, so you may need to breastfeed with two hands.

For example:
If you are feeding off your left breast, take that breast in your left hand, thumb on the fleshy part above the nipple, the rest of the hand below the nipple and squeeze it into a more pointy shape, then put as much of that as you feel you can into the baby's mouth.

Alternatively, thumb at 2 o'clock, rest of the hand at nine - if someone was looking at your breast, and gently squeeze your breast and nipple into a more pointy shape, then try to get the baby to latch.

Good luck

Sounds really, really awful. IMO though, I really think you need another opinion about the thrush.

I really don't think that you would get pain for three hours after a feed from a flat nipple and thrush is more likely. The white residue is not always visible so if the GP just used that as a diagnosis, then I would get a second opinion.

It is entirely possible to feed with flat nipples - as Dr Jack Newman says "it's called breastfeeding, not nipple feeding.". But it is harder to get them latched on well I know.

How would you describe the pain? Are your nipples healed now or still cracked?

Thank you all for your support. It is a constant dull pain (searing) which extends from the niplle right through the breast. The breast is so sore that if dd brushes her hand against it, it really hurts enough to make me wince and I have a high pain threshold. I thought it could be that the latch was the problem, but the pain is the same after I have expressed. It does eventually calm a bit but never goes entirely.

Nipples are completely healed now and have been for about a week

I have severely inverted nipples & used Medela Nipple Shields with both my girls (feeding for 22 & 16 mths respectively). I was repeatedly told by MW's that the feeding would pull out my nipples - this happened during a feed but by the next feed they would have gone back in again. I am well aware that it is breast feeding rather than nipple feeding but it is very difficult for a small baby to latch on to an engourged breast & there is no nipple touching the roof of their mouths (which helps stimulate the sucking relex). They did become used to feeding via the shields but it worked for us.

I was told shields would mean my milk supply might dry up but I have been unable to find any studies using the newer thin silicone shields which allow for more breast stimulation.

I certainly had no pain as your describing so you might have an infection (have your nipples fully healed?). I would say not to be afraid of shields - after all breast milk from a breast (even via a shield) is simpler & a lot less hassle than pumping (or FF-ing) - just make sure you have a spare in the car / changing bag so you're never without one - we once drove home from PIL's having forgotten to take one with us!!

Good luck

Good points from GraceK about using nipple shields- it might be worth a try.

Also, you might want to have a look at this from the BfN about different types of nipple pain.

Pinkseren, if you're worried about flat nipples there are some resources here, here and here (links from kellymom.com)

Glad to hear it seems to be getting better.

Thank you all very much for this. GraceK- I feel most encouraged after your experience and have already invested in the nipple shields so will see how it goes with them. Thank you also Mollcat for the resource suggestions.

Hi Pinkseren, I just wanted to say that I have "not the best nipples" (according to m/w) and in the early days dd did struggle to latch. Once or twice I used shields (medela ones) but other than this i expressed a little to pull the nipple out and take some of the fullness away - then she could latch no problem. Once she started growing and I wasnt engorged the problem has sorted itself. I think these things are always more troublesome in the early days I am afraid.
Probably worth seeing the GP re the pain though.

Wishing you all the very best.

The pain does sound more like thrush (which unfortunately you are more susceptible to if you've recently been on antibiotics). I'd agree with the suggestions on getting a second opinion and seeing a breast feeding councillor to see if a different position would help. Have your nipples changed colour? Either very dark pink / red or white and bloodless after a feed?

I had pretty flat nipples and really struggled for the first few months (cracks not healing, thrush, mastitus, thrush etc). Unfortunately the only thing that helped was putting up with it until DS to had a growth spurt. When he had a bigger mouth his latch was better and it got easier. Having said that, I didn't try using shields so that might help. I found most of the HVs, MWs, GPs etc didn't understand how painful it was (I got through induced labour on 6 co-codimol tablets but took about 200 paracetamol in the first month of breastfeeding - and would of taken more if I could have done!).