EPISODE 4

Special Nipples

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Episode Transcript

July 07, 2020

Do you think you have special nipples?!

I want you to just say to yourself, I’m awesome. My nipples are fine. And whatever choice I make, it’s going to be a good choice.

This is Maureen Farrell and Heather O’Neal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

So join us for another episode. So Heather, what are we talking about today? Nipples. Nipples. Oh, all the nipples. Did you know there’s different kinds and they don’t all have to look like the typical porn star, perfect nipple? You know what’s funny? I knew that because I have two different nipples on my body. Tell me about how you felt about that in middle school.

Oh gosh. How did we feel about any part of our body in middle school? Has anybody reconciled how they feel about their bodies? No. Maybe we should stop talking about that, but really, really, really, everybody’s nipples are different and it’s okay if your nipples also don’t look the same. I always said that if we were all meant to have the same nipples and only one specific type of nipple worked for breastfeeding, then there would be no variation.

Like babies are able to figure out how to feed off of so many different kinds of nipples and if they weren’t then nature would have taken over and bred it out of us. And we would all have the same exact identical nipple. Right, but we don’t. But we don’t because babies tend to figure it out no matter what your nipple shape is.

So, you know, tell me a little bit about that. Well, I’m going to talk about our number one offender, inverted nipples. Oh, dear. That is probably the number one nipple question I get. And it’s usually when people are pregnant and they know that they have inverted nipples. Because at this point in their life, they’ve seen a nipple or two, and they know that their nipple might be a little bit inverted, but my question is, is it truly inverted?

And I would argue that most of them are not truly inverted. And the way you can actually tell the severity of the nipple inversion is if you compress your breast and the nipple goes in more, then that’s truly inverted. But if you’re able to actually pull the nipple out at all, then it’s not truly inverted.

It’s all about the fibers that connect the tip of your nipple to the inside of your breast. And sometimes when we are fetuses ourselves, those fibers don’t tend to fully break. And then your baby will do that for you. And sometimes that can be a little bit painful, but it doesn’t mean that it’s impossible to breastfeed.

It just means it’s going to take those fibers a little bit of time to stretch out to the point where the baby has a nipple that is functional for them. So, Heather, do you find the, you know, inverted nipple, grading system useful? Do you use that? That’s what I was taught in class. You know, I don’t, because I don’t really like the, I don’t like comparing anybody to anything because it’s like, oh yes, these are the top 10 inverted nipple types.

And then what happens if you’re the eleventh? Right. You know, like, I don’t know. And it also, everybody is so different. It doesn’t really matter. I’ve seen it. And your baby is different. So the baby is the other part of this equation. Maybe you have a baby that you could latch to the wall. That just is a great breastfeeder.

And you have like, stage 10 nipple inversion, but they don’t care. They’re going to figure it out. And what if you have a stage one nipple inversion, and it’s not that bad, but your baby has a really tiny mouth and a tongue tie? I mean, that’s a bad combo. You know, not bad, but it’s something that definitely needs adjustment.

 Right or you might need a little bit more assistance. You might have to do a little bit more work. Yeah. I think labels are for soup cans and I don’t really like to put anybody in a box or any boobs in a box. Right. We definitely don’t want to box up those boobs, Heather. Definitely not. So, okay. So say you’re looking at your nipples, like right now, while listening to this podcast and you’re like, well. How do you know I’m not? Shit, Heather, put your top back on.

I’m sorry. You’re looking at your nipples. And you’re like, wow, these are inverted. I never actually thought about that before and how that might impact breastfeeding. So. What next? You don’t have a problem until you have a problem. So don’t invent this problem for yourself. You don’t know that it’s not going to be successful or easy.

So I would probably just note it like, oh, okay. This might be a thing. And you can really just cross that bridge when you fall off of it. That’s how I like to roll. I mean, you can educate yourself, but not to the point of anxiety. Right. Do you, do you feel like, cause this is something I’ve thought about.

Like if, if somebody’s got inverted nipples, prenatally, do you feel like then that person is a good candidate for someone who really should find a lactation counselor or consultant first? And make sure that they’ve got that 24-hour access to somebody? I mean, I think that that’s across the board, something that’s helpful for everybody because you could have the world’s most objectively perfect nipples and a baby with an objectively perfect mouth, and that shit’s a mess for some reason, you know?

So I think everybody across the board should know who to call, when to call, and where to go if you have a problem. But if you have inverted nipples, some things that you’re going to hear are wearing nipple shells from 36 weeks on, which the research is out on most of these things, because it’s too hard and too expensive and too risky to actually do experiments on pregnant people.

Yeah. So what I was taught and I’ll see if I can pull up the sources for this information, but I was taught that there was at least one pretty good study that showed that that didn’t make a difference. That wearing the shells prenatally didn’t change whether or not somebody was able to breastfeed.

I actually read that it could hinder it because it could, some people that have anxiety choose to do that, but then they do it so much that they actually create nipple damage. And so they’re damaged before they even begin. And then also it can’t, there are some OBS out there that say that they don’t like to recommend that because they think it causes nipple stimulation, which causes contractions, which is the least of my worries in a full-term normal, healthy situation.

If you have preterm labor and you’re trying to actively stop your labor, I definitely would not put something on your nipples that’s going to stimulate it. But all things being equal and normal, it’s probably like one of those things where if it’s going to help your anxiety, fine. If it’s going to give you more anxiety to do it, don’t do it. Right.

But when you’re using any devices on your nipple, whether it is, you know, these nipple shells, whether it’s a pump, you really want to make sure that you have a proper fit and that you’re not damaging your nipple. So every single time you use something like that, after you’re done, look at your nipple carefully and look at the underside of your nipple because we see a lot of nipple injuries get really bad when they’re on that underside.

Cause like who can see that right without flipping their boob all around or using a mirror? And that’s where we get these really bad cracks that often turn into infections and mastitis. Yeah. And there’s also the other device, it’s a nipple sucker outer. Where it’s like on a plunger and you basically syringe pull your nipple out.

And that can definitely cause a contraction, but probably not going to cause a contraction that’s going to change your cervix, unless you’re already prone to preterm labor. But some people do that too hard and too long. And the goal of it is to stretch and or break those fibers that are causing the nipple inversion.

And this is for pregnancy, this isn’t for after. This is for pregnancy, when you are trying to prepare your breasts for breastfeeding, but really there’s no preparation that you need. And, and the study that was done on that was a super small sample size and it was one guy and he really just made it up, made up the results so he could sell his product.

Yeah. And that’s a bunch of bullshit and I don’t even know why that was in the textbook that I read. Gosh, you know, I’m just going to put it out there that any product that makes me feel like my body isn’t good enough, I’m going to be skeptical of right away. And any product that I look at and say, huh, maybe I need that when I didn’t have a problem before, I’m going to be skeptical of that too.

Absolutely. Yeah. Again, it’s these companies that they sell a product that’s only good in pregnancy and lactation, which is a minimal amount of time in the marketing world. So they have to use language like, “you need this in order to breastfeed successfully.” Or “if you don’t use this, you will have a hard time breastfeeding” because they need, they have that crazy sense of urgency to sell it to you in a short amount of time.

So always be wary of the language that companies are using in their products. Yeah, absolutely. And, you know, be wary of comparing your body to somebody else’s. You know, if you see somebody breastfeeding and you’re like, holy cow, look at her nipples, they are really different from mine and she’s had this perfect breastfeeding relationship. You know, that’s, that’s a situation where you have to practice a lot of like thought control and you have to sit there with yourself and say, okay, you know, take a deep breath. My body is good. Like my, you know, I have functional breasts. I can do this. I have the ability to do this. There’s nothing wrong with my body.

You know, one of the things that, my nurse was awesome when I had my daughter, but when I went to put her to breast for the first time the nurse said the funniest thing, but it was like the nicest compliment, but also made me kind of like, think about it too much. She said, wow, you have amazing anatomy for breastfeeding. And I was like, well, she basically just told me I had nice tits.

Like, thanks for making my shift easier. That looks like something I could latch on to. You know what I mean? Like my stupid brain just went so many places with that, but then it got me to thinking like, what is good anatomy? Yeah. For breastfeeding. And does it matter? Is that even a thing? I don’t know. I mean, one thing that I think is a bigger issue is how compatible your baby’s mouth is for your particular nipple.

That’s a thing. You know what, like we, Heather and I have seen a lot of breastfeeding dyads. And I can tell you, Heather, there was maybe one single case so far where I thought, Hm, maybe that nipple and mouth just don’t fit together yet. Was that the one that I also went to? And I actually called you, I called Heather and I was like, Heather, I need help.

This person needs more help than I have time to provide. So like, let’s like, you know, collaborate. Team up and see it. But, but seriously, almost everybody I see for their birth or their postpartum has either has some kind of breastfeed issue, whether it’s short or long-term or they think they do. And most of the time it’s not, oh, your nipples don’t work.

It’s wow. Like, you know, you’re, this position you’re using with this baby isn’t quite working and we’re going to do this small thing and it’s going to be fine. And also time. Yeah. Like your baby’s mouth is not going to be that small forever. Right. Right. And with that client, I mean, like within a week it was fine. When I, by the time I got around to seeing her, she was nine days postpartum and also only one of her nipples was so large that the baby couldn’t get it in her mouth.

And I was like, okay, well, the other one will go in. So let’s breastfeed on the right breast and we can use the haakaa on the left breast, and then we can cup feed that. Like we don’t have to go to a bottle. There’s so many different things you can do.

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Oh Heather, Heather, are we going to do an episode on alternative feeding methods? No, we’re going to do a series on alternative feeding methods. Look forward to it, everybody. Please, please and spread the word, you know, it’s, it’s not all or nothing and it’s not bottle or breast. Yeah. I just, I want to make it clear, like we are a judgment free zone here.

Yeah. You know, we’re going to do our best to provide accurate information. And, you know, we’re going to be clear about medical benefits and risks and all of that, but whatever choice you make, based on that information, that can be the right choice for you. And it doesn’t have to be something that I approve of. It doesn’t have to be something your mother-in-law approves of.

Why, why do they always end up in the equation, but they do for some reason, babies and weddings give people this crazy sense of entitlement. Like, Hey, I never had an opinion before that I’ve expressed to you, but now that you’re pregnant, I have this whole textbook of opinions that I’m going to push on you. Also, I can touch your body without asking.

The other nipple that I want to talk about is a long tip nipple. Oh yeah. Tell me. So this one is very common in Asian populations and, but not strictly for Asian populations. Not exclusively, not exclusively, but yeah, a lot of people will say like, oh, the baby’s going to gag on that nipple and they will not.

They will not gag on that nipple. And if they do, guess what? No big deal, they don’t care. They still have to eat. You know, what if you gagged every time you ate, but like, you’re still, you’re not going to be like, well, I guess I’ll just starve and die. Like, you’ll figure it out. And that’s what babies do.

They just figure it out. Yeah. They adjust their latch. And there was only one time that the mom’s nipple was so long that the baby kept gagging and it was a preemie and it also was a C-section baby that was full of fluid. And so that was a temporary thing. So what we did was we hand expressed and we cup fed until that baby was cleared of all that fluid.

And then we got the baby latched and it was fine, but one of the important things I want to remind you of is many of these interventions that you have to do to get your baby to feed are temporary. So if a hospital lactation consultant says, okay, I want you to pump and feed the baby, you know, every three hours because the nipple is not working for this baby’s mouth.

Okay. The next question you have, is how long do I have to do this? And the answer for me is I like to reevaluate every 24 hours at the very most. Like you can, babies change in four-hour blocks, I think. Yeah. I mean, honestly, if, if we recommend an intervention like that in home birth, I’m usually checking in several times a day and sometimes, you know, I’m like, text me after every feed.

Tell me what’s going on because you know, you could do an intervention like that for one feed or two and all of a sudden everything is different. And maybe a different intervention needs to be tried, or maybe everything can be stopped. I agree. And then also the baby might not like that particular intervention and it might just be some tweaking that has to go on.

Right. You know, like, okay. So it didn’t like the spoon feed, so let’s cup feed, right. You know, whatever, and it’s minor. It doesn’t, it’s not a failure. It’s an adjustment. So, if you are in a situation right now where you are insecure about your nipple shape, you’re insecure about the fact that your body will be able to do this feeding your baby thing.

Just remember it’s not going to be a failure. It’s forward. Right. I hate the, any, any use of the term failure for pregnancy, birth, breastfeeding, anything. You know, especially when you know, professionals talk about like failure to progress in labor. I mean, that kind of word is just so it’s so disempowering.

And the reality is that that’s never a failure of the person having that baby, of the birthing person. You know, it’s probably a failure of the provider or the facility, or maybe it’s not a failure at all. It’s just a coincidence of factors. You know, it’s, it’s how that baby is shaped. It’s how that parent is shaped.

It’s how they moved in, in labor. It’s how the, you know, I V fluids were administered. In breastfeeding maybe it’s, you know how that baby has a slight tongue tie, but also its parent has nipples that, you know, are shaped just a little bit oddly. And you know, all of those things combined can cause us to just have to change our plan.

Yeah. I like to call them special nipple shapes. Yeah. Because you know, I had another patient who’s Montgomery glands, like the little dots, little bumps around your nipple were very large, but almost like marbles were underneath of it, but they weren’t hard. They were still squishy. Right. So you’re like, you know what? Try it. It was almost like a varicose vein just laxity of the Montgomery gland in the areola, but she successfully exclusively breastfed four babies. It was just a matter of getting enough breast tissue in the baby’s mouth. So, but she could have very easily been like, oh, my nipples are too special that I can’t do this. Like there’s no way.

Right. And you know, I think most commonly the, the issue I help people with a lot is when they have larger breasts and fairly flat nipples. And, and that combination can be really challenging. You know, it, it, it might mean that you have to hold your baby and your breast, you know. It might mean that you have to really focus on how much breast tissue is going in that baby’s mouth every single time for weeks. And using the proper support so that when you or baby gets tired of holding that it doesn’t slip down or slip out or slip out of position and then you end up with a bad latch and injury.

Right. And, you know, that’s kind of, that’s always what I’m thinking about in that postpartum. Right? Of course I’m thinking about baby’s growth and weight gain, but I’m also constantly like what’s happening with those nipples? Because as soon as we have a nipple injury starting, that can slide downhill really fast.

Well, yeah, you’re using those bad boys every two hours, sometimes. Yeah. And sometimes just a little bit of soreness within 12 hours is a full blown, bleeding, nipple injury. And that pain is excruciating and should never be downplayed. Oh, I know, I had it. I would have to, I would grip the arm of the couch as my baby latched and be like, okay.

Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. And then we’d feed and the latch would finally get deep enough and, you know, I wish I had known what I know now. Gosh, me too. It would have saved me so much trouble and pain. Right. And, you know, I had a fabulous midwife, but her specialty was not breastfeeding support.

And you know, I, I work with her sometimes now and you know, she is absolutely, absolutely admits that it’s not an area where she feels like an expert in. And, you know, I live really rurally. And I just didn’t have anybody else to go to. And so when I had sort of exhausted her advice, that was it. I was like, I guess I’ll read this on Ida May book on breastfeeding again, grin and bear it.

Right. And you know, one day guys, I am going to lead the episode about thrush and recount the excruciating pain of that. But you know, let me tell you, most breastfeeding parents are no strangers to pain. It, unfortunately for a lot of people it’s painful and I will also say that it doesn’t have to be. Right.

It doesn’t have to be, but sometimes there is a period of time where it is a little bit uncomfortable and it’s just. I have had those patients though, where we’d go through every single thing and it’s still just a little bit painful for them. And even in that scenario, it does eventually end, right? The baby’s mouth either gets bigger.

Your nipples get tougher. You can take ibuprofen for that shit. Oh, absolutely. And I’m all about all-purpose nipple ointment as well. Yeah. So yeah, I mean, it’s kind of just cost benefit. Like if, if it is so painful for you with your special nipple shape and your baby’s mouth that you cannot push through, even after every intervention, even after assessing the latch, adjusting tongue ties and lip ties.

If you are at the end of that rope and you make a choice to supplement and give your nipples a break, fine. If you make the choice to ween, fine. As long as you’re educating yourself on why and when, and if you’ve really tried everything if you just wake up one day and you’re like, I’m done, that’s also fine.

Here’s how I think about it. Like, here’s the mark of a really supportive care provider. When you’re having issues like this, most care providers are gonna, are gonna help you with some solutions and some interventions, but the real key is, are they asking you if that’s you want? Do you want to do this? And if it doesn’t work, do you want to do another thing?

If that doesn’t work, do you want to keep trying? And if you want to try every single trick in the book, great. And if you try one or two things and you are, you’re like I have to tap out, I can’t do this. That’s also great because you know what you want, you know your limits and you can make another choice. I agree.

And you should never leave your provider’s office feeling less than. Because that is not a reflection of you. That’s a reflection of your care, right? So if you leave feeling less than in any way, it’s time to get a new provider. So everybody listening right now, I want you to just say to yourself, I’m awesome.

My nipples are fine. And whatever choice I make, it’s going to be a good choice. Yeah. Heather and Maureen totally have your back with whatever choice you want to make in whatever nipple shape you have and whatever baby mouth situation you have going on. It’s probably going to be something that can be worked out.

So everyone look at your nipples and say to them, Hey, nipples, I know I probably haven’t talked to you in a long time or ever, but I appreciate you and all the work you’re about to do or the work you’ve already done. Let’s appreciate our nipples today. And you know what? Like feel free y’all to write in our comments or send us an email and, you know, just like, I don’t know, tell us about your nipples or tell us about some other person’s hypothetical nipples that you might’ve seen at some point.

And I don’t know, like, you know, we love comments, we love questions. We love to talk about them on the show. So, you know, send them in. Who doesn’t love to talk about nipples? We’ll see you next time.

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