The pinch test

What is a pinch test?

A pinch test is a way of testing the nipple root, the part of the breast that, along with the nipple, goes into the baby’s mouth during breastfeeding, to get an idea of how well it will work. You can’t tell just by looking at the breast. In the test, the thumb and pointer (index) finger are used to gently squeeze and roll the tissues of the root, the area just behind the nipple. In a normal test, the root is soft and it is easy to hold on to. It is thinner than the nipple itself. The muscles of the areola are relaxed and there is no tightness holding the nipple to the breast. The pinch test can identify a number of problems in the nipple root that can result in pain for the mother or in the baby not being able to latch or take in enough milk.

A) Reason for using the pinch test

This is a normal pinch test: The area behind the nipple is easy to grasp and there is no cord holding down the nipple.

The way the nipple and nipple root respond to the baby’s mouth determines whether the baby will be able to latch and breastfeed effectively and whether the mother will have nipple pain and damage. 

To prevent these problems, the nipple and root need to work normally. 

You can’t tell just by looking at a breast whether it is going to work. Some nipples look normal but may be partially or fully inverted and others look inverted but may be normal. The nipple root may look normal but be very firm. The pinch test identifies these abnormalities.

The pinch test allows you to feel the tissues of the nipple root and how they work together with the nipple in response to being stretched and compressed as they would be when the baby breastfeeds.

B) Doing the pinch test

It is called the pinch test, but you don’t really pinch the nipple. You just feel the nipple root and its relationship to the nipple and the rest of the breast with your fingers in a pincer position.

To do the pinch test:

  • Adopt a pinching position, as if you’re about to squeeze something between your thumb and pointer (index) finger.
  • Place these digits opposite each other on the part of the areola closest to the nipple (the central areola)
  • Apply a little pressure and slowly roll the nipple root between the finger and thumb.

C) A normal pinch test

In a normal pinch test:

  • The nipple root is soft, not firm.
  • You can easily grab the nipple root between your thumb and forefinger.
  • The nipple root is thinner than the nipple itself.
  • There is no tightness of the nipple root.
  • There is no thick rope of tissue (cord) running from inside the nipple, through the nipple root, back into the breast.
  • The muscles of the areola are relaxed, not tense.

Inverted nipples can be identified before or during pregnancy, or after birth. If you do the pinch test when you are pregnant, the nipple root may feel a little tight. This is normal. As you go through pregnancy, the root usually becomes more elastic and easier for the baby to latch onto. If the nipple feels very tight, this abnormality may persist after the birth of the baby.

D) An abnormal pinch test

Abnormalities in the pinch test are described in the following chart.

Table: Pinch Test Result and Interpretation

(Links to more information about the topics in the above table: nipples that are shy, dimpled, inverted or have nubbins; a firm nipple root.)

Inverted nipples can be identified before or during pregnancy, or after birth. If you do the pinch test when you are pregnant, the nipple root may feel a little tight. This is normal. As you go through pregnancy, the nipple root usually becomes more elastic and easier for the baby to latch onto. If the nipple feels very tight, this abnormality may persist after the birth of the baby.