I agree that there is a fair amount of edema seen in women's breasts which causes latch difficulty, but as a hospital LC for the past 17 years, I can tell you that more often when I am told that a woman has "flat" nipples by the nursing staff, it is because they don't know what else to say about why a baby won't latch.  Mostly when they tell me this, I roll my eyes (inside my head, not so they can see :) and go in and help the mother latch the baby, hopefully with the nurse watching and learning. Usually it's a combination of an awkward mother and a baby who's a little disorganized; extremely rarely does the mother have truly flat nipples...often they are protruding just fine and I can't think why they would have considered them flat.  The bad thing is that then I have to convince the mother that no, she does NOT have flat nipples when she's been hearing it all night from the nurses. And yes, in 17 years the nurses have GREATLY improved their skills in helping mothers breastfeed, but I still get this "flat nipple" thing when they don't know what else to say.

Melinda Lueck, RN, BSN, IBCLC
Perrysburg, Ohio


-----Original Message-----
From: Lisa Marasco IBCLC [mailto:[log in to unmask]] 
Sent: Tuesday, December 29, 2015 1:17 PM
Subject: Re: flat nipples

Allyson,
As an outpatient lactation consultant, I have women coming in telling me that they have had latch difficulties and that the hospital LC told them that it was due to their flat nipples. The problem is, when I see them, their nipples are not flat even though by then they have "owned" the label.  What I suspect is happening in these cases is that labor drugs are causing edema that flattens out the nipples temporarily, disrupting latch attempts by baby. RPS would be my first step if I were an in-house LC.  I explain to the mother that what the hospital LC saw was likely different than what I am now seeing, and why. And then we move forward.  So when it comes to what the OB offices are missing, and they don't all screen for such things, keep in mind that perhaps what you are seeing is *not* what they saw in the office. 

~Lisa Marasco, MA, IBCLC

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