Many changes occur in a woman’s breasts during her pregnancy and after the baby is born. When new mothers come to me with breastfeeding difficulties, and I ask them if their nipples are “cracked”, they sometimes are not sure. “I don’t know what my nipples looked like before the baby started to suck on them. Do they look normal now?”
To get a sense of what equipment you are starting out with on your breastfeeding journey, it might be a good idea for you to go on a “Breast Field Trip” at the end of pregnancy.
(Please note: If you have concerns about your breast health, or if you have had breast surgery, some of this may not be relevant to you. Please see your doctor or midwife and consider setting up a prenatal appointment with a Lactation Consultant (IBCLC) to prepare for any challenges you may encounter when breastfeeding your baby.)
1. Take your top and bra off and stand in front of a mirror with good lighting.
2. Look at your breasts. You may notice:
• Your breasts are bigger than before you got pregnant. Most of the glandular tissue you need to make milk grows during pregnancy. And all the little ducts that are needed to transport the milk grow then too. Some breasts grow a lot, and some grow only a little, but they almost all grow some.
• One breast is larger that the other. As breasts grow, the difference in size between them (and there is almost always a difference in size) becomes more apparent.
• Your breasts are not symmetrical. One nipple may be lower than the other. One may point more to the left, or more to the right. Knowing that your breasts are not symmetrical may help you figure out how to position your baby at the breast.
3. Look at your nipples. You may notice:
• Your areola (brown or pink part of the breast around the nipple) has become bigger and darker.
• You may have more visible or darker bumps on the areola. These are sometimes called “Montgomery’s tubercles” but they are more descriptively called Sebaceous Glands of the Areola. They secrete an oily substance that keeps the nipple and areola supple and smells attractive for the baby. The smell helps the baby find the nipple.
• Your nipples may be bigger and darker than before. They may stick out more. The skin may be crinkly (the anatomical term for the crinkles is “rugae”) (These crinkles are not “cracks.” When a baby attaches to the breast too shallowly, and the nipple get pinched, a blood blister may form and then a wound may develop. That is what people mean when they talk about “cracked nipples.”)
• Your nipples may only stick out if they are touched, massaged or get cold. If that is the case, you may have “flat nipples.”
• If your nipples retreat when you compress the areola, you may have “inverted nipples.” This is caused by short connective tissue within the nipple. Check with your doctor or midwife to make sure.
• Inverted or flat nipples make people feel worried about being able to breastfeed. Don’t worry! Babies use the nipple as a guide to tell them where to latch on. Flat and inverted nipples make it a little more difficult for the baby to FIND the nipple, but you are going to be there to help! The baby is supposed to take a big mouthful of breast, including the nipple and much of the areola, so the size of the nipple or invertedness of the nipple should not matter. Many parents find that after they have been breastfeeding for a few weeks, their nipples stick out and become easy for the baby to find.
• There are gadgets and exercises out there to “fix” inverted nipples. There is no scientific evidence that those gadgets and exercises work. The best way to deal with flat or inverted nipples is to get expert breastfeeding help after your baby is born.
4. Pull gently on your nipples and see how far out they stretch.
• When a baby is connected properly to the breast, the tip of the nipple is all the way at the back of the baby’s mouth – at the soft palate. When I tell moms this, they imagine that their own little nipple could never reach that far. But nipples and areolas are very stretchy! Check it out!
• A generation or two ago, mothers-to-be were told to “prepare” their nipples by scrubbing them with a rough towel or rubbing them with alcohol! This is no longer recommended. It does nothing to prevent sore nipples, in fact it may damage the skin of the nipples and make them more tender.
5. Try to express a little colostrum. (These directions are given for your right breast. Try your left breast first if you are left handed!)
• Hold your right breast in your right hand.
• Have your little finger all the way back at your chest wall and your other fingers supporting the weight of the breast.
• Have your thumb on top. Move your finger and thumb back towards your chest, away from the areola, and then slide them forward, compressing the breast tissue.
• When you get to the base of the nipple, stop and maintain the pressure for a few seconds.
• Don’t pull on the nipple – that just pinches the ducts closed.
• Imagine there little “grapes” under the skin and you have coax the “juice” out of them!
• Move your hand around so you try all different angles around the breast – all different points of the compass.
• You may need to try for several minutes before you see a few drops of colostrum. It takes some time to get the knack.
• Some women see little beads of yellow colostrum on their breasts during the second half of pregnancy. Some see little yellow crusts of dried colostrum. Others don’t see colostrum at all. But almost every woman makes colostrum after about 20 weeks.
• Expressing or leaking a little colostrum does not “waste” any, because your breasts will continue to make it until about 10 days after the baby is born.
• The purpose of expressing colostrum here is just for you to develop a better understanding of how your breast works. You don’t have to do it. If you express colostrum now, it does not mean that you will make more (or less) colostrum later. If you can’t, it doesn’t mean there isn’t any. It probably just means you haven’t figured out how to do it yet. Try again later, or wait for your baby to figure it out.
6. Look at your breasts again and think about what wonderful “equipment”, what beautiful “packaging” they are for making and delivering milk to your baby!