After your baby is born, you may want to wear the shells for 30 minutes before nursing in order to help draw the nipple out further. Once again, any milk that collects during usage should be discarded and not given to your baby.
The Hoffman Technique is a manual exercise that may help break adhesions at the base of the nipple that keep it inverted. Place the thumbs of both hands opposite each other at the base of the nipple and gently but firmly pull the thumbs away from each other. Do this up and down and sideways. Repeat this exercise twice a day at first, then work up to five times a day. You can do this during pregnancy to prepare your nipples, as well as after your baby is born in order to draw them out.
Gentle manual or oral stimulation of your nipples can be a part of lovemaking, and may encourage your nipples to protrude. Your partner will enjoy helping you prepare your nipples for nursing.
After your baby is born, you can use a breastpump to draw out a flat or inverted nipple immediately before putting your baby on the breast. Pumping can also be useful in order to break the adhesions under the skin by applying uniform pressure from the center of the nipple. If the nipple is truly inverted, (which is usually present in only one nipple rather than both), you may need to use the pump to provide stimulation and supplement with your milk. This is especially the case if the inversions are present in both nipples. Usually, after the first few nursings, the baby's vigorous sucking will exert negative pressure and help the tissue protrude. With both flat and inverted nipples, the baby will become better at grasping and drawing the nipple into his mouth as he gets bigger and stronger.
If your nipples are flat or inverted, it is helpful if you have help from a Lactation Consultant if possible during the first feedings, as these are likely to present the most problems. Useful techniques include:
Stimulating your nipple. Unless it retracts completely, grasp the nipple and roll it between your thumb and index finger for 30 seconds, then touch it with a moist, cold cloth immediately before offering it to your baby. A disposable nursing pad that is dampened and put in the freezer makes a great ice pack to help the nipple evert immediately before nursing.
Pulling back on the areola before you latch the baby on. Support your breast with your thumb on top and your other fingers underneath, and pull back on the breast toward the chest wall. This will help the nipple protrude.
Using a nipple shield. This is a thin, flexible silicone nipple with holes in the end that fits over your nipple during feedings. Nipple shields got a very bad reputation years ago when they were made out of thick rubber, and caused a significant decrease in the mother's milk supply. They were handed out freely to new mothers in order to 'reduce nipple soreness' or to get babies to nurse at the breast. Under these circumstances, they created more problems than they solved.
While nipple shields should only be used when a lactation professional recommend and supervises their use, they can be helpful in certain situations. They should be used cautiously, since their misuse can cause a decrease in the amount of milk the baby receives, as well as causing nipple confusion.