Breastfeeding is the undisputed optimal feeding method for infants. In response, Healthy People 2020 called for an increase in the number of infants who are breastfed at 1 year to 34.1%. The Centers for Disease Control and Prevention reported the breastfeeding rate for 2012 as only 25.5%. To accomplish the breastfeeding goal of Healthy People, mothers need excellent breastfeeding support throughout the entire first year, especially when faced with difficulties. Studies have shown an overwhelming number of infant health benefits associated with breastfeeding, including protection of the infant from bacteremia, diarrhea, respiratory tract infection, necrotizing enterocolitis, otitis media, urinary tract infection, late-onset sepsis in preterm infants, type 1 and type 2 diabetes, lymphoma, leukemia, Hodgkin's disease, and childhood obesity. The more breastfeeding support a mother receives, the more likely she will be able to offer these benefits to her child. This support is even more important when a mother faces challenges, such as flat nipples, that put her at risk for breastfeeding failure.
In a typical case, a first time mother with flat nipples had difficulty with her infant successfully latching on to the breast. Initially, skin-to-skin contact and frequent breastfeeding attempts were made. The lactation consultant (LC) or postpartum nurse taught her how to hand express so that her infant could receive colostrum. If latch on is not achieved within 24 hours of life, the patient is educated on breast pump initiation. During this same time, the patient is taught how to spoon and finger feed her newborn. After discharge, the patient follows up with outpatient lactation services. If the newborn is still unable to latch on and lactogenesis II has not yet occurred, the mother was taught how to use nipple shields and a supplemental nursing system (SNS). The mother was followed by her pediatrician and outpatient LC. Once this mother achieved full milk supply, the SNS was discontinued. Soon after, attempts were made to wean from the nipple shield. At 5 weeks postpartum, the infant was exclusively breastfeeding without any interventions.
All mothers with flat nipples who are experiencing breastfeeding difficulties should be given the same opportunity to use every evidence-based resource available to them.