Health

Vitals & Bits #9: The Nipple

As a former maternal-newborn nurse, I’ve witnessed a variety of behaviors from new parents. These behaviors run the gamut from utterly predictable to amusingly zany. Some new moms ask for a beer the minute the baby has exited the birth canal, while others bedazzle their hospital rooms with unlit incense and prayer beads. But “new mom” behavioral quirks pale in comparison to what I’ve seen new fathers do.

While most fathers-to-be offer support, love and respect during the childbirth experience, some men seem to have poorly calibrated barometers for appropriate behavior. These inappropriate behaviors often involve their partner’s breasts or nipples. Why the nipple is so often the target of poor behavioral choices by men is still a mystery to me, but perhaps it has something to do with the fact that in our culture, the female breast is seen more as an iconic sexual object rather than a functional anatomical structure. It might also have to do with general lack of knowledge about how the breasts and nipples work.

For instance, on more than one occasion, I’ve witnessed men try to suck on their wives’ nipples during labor. While it’s true that nipple stimulation can help jumpstart a waning labor, I don’t understand why a man would choose to attempt this maneuver while the baby is halfway out of the birth canal. Nor do I understand why a man, lacking breasts or any medical background of his own, would criticize his girlfriend’s breastfeeding attempts and coach her on doing it “his way.” I’ve also seen men giggle childishly, crack dirty jokes or become visibly angry while their partner attempts to breast feed for the first time.

I was teaching one new mom how to get her baby latched on to her breast with the father reached out and pinched the tip of his wife’s nipple. “Ouch!” she exclaimed.

“Why on Earth did you do that?” I asked the man.

“I wanted to see milk squirt out,” he replied, shrugging.

Like many people, this guy thought that pinching the tip of the nipple would cause milk to squirt out like the stream from a water gun. His behavior betrayed not only a lack of sensitivity to his partner but also a lack of knowledge regarding the anatomy and physiology of the human body. Believing that the tip of the nipple is a singular milk spout is a pretty common misunderstanding, and I have found that lack of “nipple knowledge” occurs frequently among both men and women.

I explained to the man that contrary to popular belief, the female nipple doesn’t contain one hole in the middle. Instead, the whole nipple is studded with pores through which milk exits the breast. These pores are outlets to the lactiferous (milk-producing) ducts within the breast.

A breastfeeding baby doesn’t withdraw milk from the breast by sucking in the way that one sucks through the straw. Rather, suckling is more like a coordinated, rhythmic motion of the mouth, tongue, and jaw designed to compress and “milk” the lactiferous ducts. The baby has to get as much of the areola (or darkly-pigmented skin encircling the nipple) in her mouth as possible in order to compress these ducts and draw the milk out. It’s important that the baby get as much of the areola in her mouth as possible because the pigmentation of the areola roughly delineates where the ducts of the mammary glands are.

A baby who is just hanging on the tip of the nipple won’t have her mouth far back enough to compress the ducts and therefore won’t get any milk, just like squeezing the very tip of a tube of toothpaste won’t get you any toothpaste.

Also contrary to popular belief, breastfeeding isn’t a “natural, instinctual” process for most moms and babies. Breastfeeding is hard! Although I’ve seen a handful of first-time moms successful latch baby on the breast and continue breastfeeding without problems, this seems to be the exception to the rule.

There are a few reasons why breastfeeding is more of a challenge than an instinct. While babies are born with a suck reflex, the coordination of sucking, swallowing and breathing is a learned skill requiring sufficient neurological maturation to achieve. Breastfeeding is also a learned skill for moms, who often face obstacles like anatomical mismatch between the size of baby’s mouth and the size of mom’s nipple. Moms also have to learn how to position baby, latch baby onto the breast and read infant feeding cues (which seem totally inscrutable at first). Anxiety and misinformation don’t help matters.

I’m not trying to compare women to cows here, but we’re all mammals, so anyone who has ever milked a cow will have a good feel for how the lactation process works. Milking a cow doesn’t involve just squeezing the cow’s teat. Instead, your hand gently compresses from top to bottom and then pauses to allow the milk ducts to refill before repeating the motion. Milking a cow isn’t an intuitive, instinctual motion. It’s actually kinda difficult and requires practice before you get the feel for it. Similarly, breastfeeding requires learning and practice. Luckily, most mom and baby dyads, with a little appropriate guidance and patience, will totally rule at breastfeeding after a week or so.

Men who are curious about how lactating breasts work are advised to take a trip the dairy farm. Practicing on a cow is more socially acceptable than trying to suck, pinch or manhandle your partner’s nipples in the labor and delivery room.