Outcome of Nipple Puller Use during Antenatal Care in Short Nipple Pregnant Women: A randomized controlled trial

Main Article Content

Nongyao Baiya Sukwadee Ketsuwan Suchasinee Thana Pawin Puapornpong


Objectives: The aim of this study was to compare the nipple length of the short nipple pregnant women who used nipple puller or not during antenatal care.
Materials and Methods: A randomized controlled trial was conducted. The pregnant women who were classified as low risk pregnancy and the nipple length less than 7 millimeters at the first antenatal visit were randomized into two groups; 125 cases of nipple puller use group and 125 cases of routine follow-up group. The first group, the mothers were taught by nurse and practiced nipple puller use twice a day until delivery. The second group or comparison group, the mothers had routine follow-up during antenatal care. When the mothers delivered, the nipple length was measured again at the first day postpartum and compared with the previous measurement. The demographic data and nipple length between both groups were compared using chi-square test and student t-test.
Results: The mean nipple length of the nipple puller use and routine follow-up group was not significantly different at first antenatal visit. In routine follow-up group, the mean right nipple length was 5.3 ± 1.4 millimeters at antenatal care clinic and 5.6 ± 1.4 millimeters at postpartum. The mean left nipple length was 5.0 ± 1.2 millimeters at antenatal care clinic and 5.4 ± 1.2 millimeters at postpartum. In nipple puller use group, the mean right nipple length was 4.7 ± 1.5 millimeters at antenatal care clinic and 9.5 ± 1.7 millimeters at postpartum. The mean left nipple length was 5.1 ± 1.6 millimeters at antenatal care clinic and 9.4 ± 1.7 millimeters at postpartum. The nipple length differences between routine follow-up and nipple puller use groups were statistically significant at postpartum (p<0.001).
Conclusion: The nipple puller use during antenatal period could increase nipple length.

Keywords: nipple puller, nipple length, short nipple, antenatal care.


Article Details

Original Article


1. Puapornpong P, Manolerdthewan W, Raungrongmorakot K, Ketsuwan S, Wongin S. Factor effecting on breastfeeding success in infants up to 6 month of age in Nakhon Nayok province. J Med Health Sci 2009;16:116-23.
2. Puapornpong P, Raungrongmorakot K, Paritakul P, Ketsuwan S, Wongin S. Nipple length and its relation to success in breastfeeding. J Med Assoc Thai 2013;96 Suppl 1:S1-4.
3. Scott JA, Landers MC, Hughes RM, Binns CW. Factors associated with breastfeeding at discharge and duration of breastfeeding. J Paediatr Child Health 2001;37:254-61.
4. Thompson LA, Zhang S, Black E, Das R, Ryngaert M, Sullivan S, et al. The association of maternal pre-pregnancy body mass index with breastfeeding initiation. Matern Child Health J 2013;17:1842-51.
5. Buranawongtrakoon S, Puapornpong P. Comparison of LATCH scores at the second day postpartum between mothers with cesarean sections and those with normal deliveries. Thai J Obstet and Gynaecol 2016;24:6-13.
6. Perez-Rios N, Ramos-Valencia G, Ortiz AP. Cesarean delivery as a barrier for breastfeeding initiation: the Puerto Rican experience. J Hum Lact 2008;24:293-302.
7. Hill PD, Johnson TS. Assessment of Breastfeeding and Infant Growth. J Midwifery Womens Health 2007;52:571-8.
8. Chaves RG, Lamounier JA, Cesar CC. Factors associated with duration of breastfeeding. J Pediatr (Rio J) 2007;83:241-6.
9. Chanprapaph P, Luttarapakul J, Siribariruck S, Boonyawanichkul S. Outcome of non-protractile nipple correction with breast cups in pregnant women: a randomized controlled trial. Breastfeed Med 2013;8:408-12.
10. Thanaboonyawat I, Chanprapaph P, Lattalapkul J, Rongluen S. Pilot study of normal development of nipples during pregnancy. J Hum Lact 2013;29:480-3.