Inverted nipples can make breastfeeding a difficult experience for both a new mother and her newborn, and this could prevent the opportunity of exclusive breastfeeding. Here's all you need to know to save the day.
As you are reading this interview, Mrs. Lorrita Nwakasi has probably retired, but she surely left something behind, important breastfeeding lessons that will benefit pregnant women and new mothers. MeMrs NwakasiLet's start by you telling us your name and your designation.OK. My name is Mrs. Loritta Nwakasi, I am a nurse-midwife, nurse-tutor, nurse-educator, and also, I did health and hospital management at Imo State University.For how long have you been practicing?I’ve been in this service for 34 years.That’s a long time…Almost making my way to rest in my house. After serving my country for 34 years I need rest.So when are you planning to rest?Yes…. From 2014 August. I will retire.I wish you the bestThank you.So what’s your position now?I am a Chief Nursing Officer.We are talking about breastfeeding for babies. A mother that has just been delivered of a baby is having challenges breastfeeding the baby. The doctor said she had inverted nipples. What are inverted nipples?Well, inverted nipples are those nipples that are not erect. The nipples goes a bit inside and not outside as it should be.They are not pointing out?Yes, they are not pointing out like normal nipples should point out so if this problem is not picked during antenatal care, it causes a big challenge during breastfeeding. So when a mother is pregnant and comes for supervision, we do what we call breasts evaluation, and during breasts examination, we look at the breasts, palpate it and make sure that there is no lump and make sure that the breast is prepared for breastfeeding because there are signs to tell you that the areola is ready, the nipples are ready.What are these signs?For instance, if you touch the breast and it is full and tensed up, the areola becomes darker. If you press the nipple there’ll be milk or what we call colostrum coming out, which shows that this breast is getting ready for the baby’s feed.That’s after the birth?No, during antenatal care, during pregnancy.Oh…Yes, because it is during pregnancy you get milk from the breast and we call it colostrum and this is the first milk that the baby will take after birth. So, if proper check is not done, something like inverted nipples can pose a very big challenge during breastfeeding but if you are careful, examine the breasts very well, you will notice it during pregnancy and you will advice the mother on what to do. In most cases you help the mother during antenatal care when you are doing cross-examination to pull out the nipples. You pull out gently and you tell the mother how to do it at home.The husband can as well help the pregnant woman to do it at home. The pregnant woman too can use a soft towel dipped in warm water to clean the nipples because if you check the nipples during pregnancy there are clumps that will block the ducts. The ducts are those areas that will allow milk to the outlets. So when you squeeze the breast during examination and this colostrum is not coming out then you should suspect there are clumps and you advise the mother on what to do at home - clean the breasts, pull out the nipples if inverted but if the nipples are erect, the nipples are pointed out. Then the mother just needs to clean… from the areola to the nipples and continue to squeeze the milk out because that will show the mother that the breasts are preparing milk. When you squeeze and there is dryness-there is no milk, you come back to antenatal clinic and report. We’ll take note of that and deal with that before delivery. So in case there is delivery now and the milk is not coming out, what can a mother do?Yes, we still examine the breasts; we’ll now squeeze out or try to press out the nipples. If we don’t see any fluid coming out we’ll suspect there are clumps and we’ll then clean the nipples and start pulling out. So if we do it several times, as long as we can in a day, you’ll notice that the milk will start coming, and as you put a baby regularly to breast, the sucking reflex of the baby will also help the milk to flow and you’ll make sure the mother is in a good condition with a stabilized mind, feeling very well because all these things encourage breast milk formation.If the mother is taking enough fluid, enough fruits, adequate rest, it helps the breast milk to form because when the brain is at rest, relaxed well, it will encourage the area of the brain that is in charge of breast milk to function well. Do you know the name of that area of the brain?That is…?That helps produce breast milk.Yes. It is… prolactin; the area is located at the pituitary gland. When the baby is sucking, a message is sent to this area and there is a reflex to the area that produces this milk that the baby needs this food to be ready. Yes, and this will produce the milk and send it to the breast and you will get the milk through the nipples from the ducts.I’ve seen this situation in which the milk is not coming out, it’s not enough for the baby and from all indications the baby is hungry but there is not enough milk from the breasts. What is the alternative in this situation?In a standard hospital like ours, we have a pediatric unit with well-trained pediatricians that take care of these types of situations. The team Doctor-in-Charge of the patient will write what we call Consult. This Consult means inviting the pediatrician to come and review the baby and review the breast milk itself. If they review the sucking reflex of the baby and find it adequate and they review the breast milk and find it inadequate, they will try to trace the cause. If the cause is as a result of inverted nipples or as a result of mother not taking enough fluid they will advise her appropriately. But if they need intervention in order to avoid hypoglycemia in the baby, they will recommend what we call pre-nan.What’s that?Pre-nan.What’s pre-nan?Pre-nan is that artificial milk that you give babies during the neonatal period. It’s not the same as the normal Nan you give to a mature baby.Is it all these ones with 0-6 months written on them?Yes. You know it’s in categories, 0-2 months, 0 to 6 weeks, 0 to this and that.But artificial milk is discouraged for a newborn and exclusive breastfeeding is preferred…Artificial milk is discouraged but when there’s a necessity like this, you don’t have options. You can’t say baby will starve until breast milk comes… the baby will be taking the little that is coming from the mother and as you augment until the breast milk starts flowing well, you stop. You stop augmentation.Generally, what are you going to say about breastfeeding?I will say that every mother needs to get prepared for breastfeeding during pregnancy. Any challenge that you know that may pose obstacles to the breastfeeding, you report it to your midwife and your doctors so that the challenge will be tackled in good time. So, after delivery, you wont have problem with breastfeeding. Adequate education will be given to mothers during pregnancy so that they will get ready for breastfeeding because you have to talk to them about their feeding, as it is very important for formation of breast milk. If the feeding is not adequate, the breast milk will not be adequate. But if you tell them the necessary things to eat and drink during pregnancy, that would help them to make the breast milk rich and flow in good time for the baby. During pregnancy, pregnant women need to sleep and rest because all these things go to how the brain will do its functions well.And then, at what week should the breast milk start coming out?By first trimester. We call it trimester but in a layman’s language its three months. By this time you should start seeing colostrum.Ok, can you tell us you name again?I am Mrs Nwakasi LorittaNwa..Nwakasinkpa in my languageWhich means…A child is more valuable than any other thingWow…Yes!And you are taking care of them?Yes…and my other name is Nwakaego which means a child is greater than richesYes…ha-ha, you're right, the name is right!I am a Chief Nursing Officer at National Hospital, Abuja, working in post natal unit supervising women in preparial period because after delivery you come to us, this is the area you rest and we look after you, check you, see that you are not bleeding, you are not in any danger. That’s what we call PrepariaLIf you have beneffited from this, share it on Facebook and Twitter so that a lot of families can also benefit from it. Talk to every pregnant woman or her husband that you know about the importance of exclusive breastfeeding. Always take actions that will help save lives of mothers and babies.Need more facts on breast milk? 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