Many changes occur in your breasts or chest during your pregnancy and after the baby is born. When new parents 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 lactation journey, it might be a good idea for you to go on a “field-trip” at the end of pregnancy.
(A note about language: I am sometimes going to use the word breast in this article, to refer to the two groupings of mamary glands on either side of the upper chest. Not everyone who is planning to lactate calls their mamary glands “breasts.” If this is your case, please insert whatever word will make you feel more comfortable. This is your field trip.)
(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 (if you are wearing one) off and stand in front of a mirror with good lighting.
2. Look at your breasts. You may notice:
• Your mamary glands 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 side 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 two sides 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 sides 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 (pink or brown part of the skin 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. You may think that your own little nipple could never reach that far. But nipples and areolas are very stretchy! Check it out!
• If you had been pregnant 40-50 years ago, you would have been told to “prepare” your 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 side. Try your left side first if you are left handed!)
• Hold your right side 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 glands.
• 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 pregnant parents 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 pregnant person makes colostrum after about 20 weeks.
• Expressing or leaking a little colostrum does not “waste” any, because you 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 mamary glands work. 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 chest again and think about what wonderful “equipment”, what beautiful “packaging” you have for making and delivering milk to your baby!