The Nipple Shield Controversy

Ever since I started my career as a Lactation Consultant, the controversy over the use of nipple shields has been a hotly debated topic. Some people feel that nipple shields are evil and should never be used under any circumstance. Then there are others who think they are useful when used appropriately under the guidance of an LC. I happen to fall under the latter. I am a believer in the use of nipple shields. Not only from my own personal experiences with them, but also from countless successful situations when I have used them with patients and clients alike.

For those of you aren’t so sure what a nipple shield is, it is a small thin silicone barrier that fits over the breast. The tip of it somewhat resembles that of a bottle nipple.  It can be used when a baby is having a difficult or near impossible time latching to the breast. Women with very flat, or inverted nipples may find success with getting their baby to maintain a latch and breastfeed with a nipple shield. Some premature babies who have difficulty maintaining suction at the breast can also benefit from the use of a shield. Mom’s that have an overabundant milk supply and who ‘drown’ their babies with a fast milk flow, may also benefit from using a nipple shield.  A nipple shield is always meant to be a temporary solution to a breastfeeding challenge and should always be used under the guidance of a Lactation Consultant (IBCLC).

The foundation to ensure that breastfeeding gets off to the best start possible involves getting a good latch. If a baby is not latching well to the breast, then a nipple shield is basically like a band-aid. It will ‘cover-up’ the problem, but it won’t address the issue at hand. I don’t believe that any mother should take it upon herself to try and figure out how to use of a nipple shield unless she is under the guidance and support of an IBCLC. Firstly, we like to wait until a mother’s milk has come in before offering a shield. Some studies have shown that if you introduce a shield before milk has come in, there is the potential to compromise supply. This is due to the fact that we are placing a ‘barrier’ between baby’s mouth and the breast and the stimulation to the breast is not as good.  I have yet to see this theory actually proven with myself, or with the clients I have worked with. Most of the studies conducted on the use of nipple shields, were performed many years ago when thicker, rubber shields were used. These older versions of nipple shields did inhibit supply as they were so thick that there was hardly any contact with baby and breast! Today’s shields are made with a much thinner silicone material that provides more direct contact with the breast.

Sometimes the shield can be a real pain in the butt to place on the breast. If a mother hasn’t been taught how to properly apply a shield to her breast, I usually see her just ‘place’ it on top of her nipple. This is incorrect and will only lead to frustration for both her and baby. Proper shield placement needs to be taught and demonstrated by an IBCLC. First, It needs to be almost fully inverted, then placed over the nipple, then STRETCHED out really well before creating suction onto the breast. It must get suction on the breast or it will most likely slip off. It does take some practice.....and patience.

As I have mentioned before in previous blog posts, I had a variety of breastfeeding issues with my daughters. With my first daughter, my nipples were so damaged right off the bat that I needed to use a shield within the first week of breastfeeding. I made an appointment with a Public Health Lactation Consultant to help me figure out how to overcome all the pain I was having. I’m pretty sure it was at this appointment that I was offered a shield. I also had an oversupply so it did help to slow down the flow of my milk but in hindsight, Kayla had a tongue tie that needed to be clipped (again) and the real issue of ‘getting a good latch’ wasn’t truly  addressed. Yes, the shield helped as it allowed me to breastfeed my daughter which I so desperately wanted to do. But it didn’t magically make everything better. I still had pain when I fed her, my damaged nipples weren’t totally healing, but at least they weren’t breaking down further. I was very thankful to the nurse who offered me the shield, but at the same time, I knew that I wanted to get rid of it sooner than later. But if it were not for that nipple shield, I probably wouldn't have continued breastfeeding.

When I suggest and then offer a shield to a mother, it is always with the intention of it being used short term and with the idea that she continues to offer the bare breast at the start of the feed. There is a misconception out there that women with flat nipples cannot breastfeed. This is not true as baby’s do not nipple feed…they breastfeed. With the correct shaping and support of the areola and nipple, most babies can achieve a deep and successful latch. But there are definitely some instances where a baby is not able to latch. Or they can latch on to the breast, but can’t maintain a latch due to prematurity, inverted nipples or very dense breast tissue. This is when a shield can be a good tool to use in order to help the baby stay latched on.

I am also a Lactation Consultant who will sometimes (and I stress sometimes) offer a nipple to shield to a mother before her milk comes in. I know this is fairly controversial and not a lot of people like this idea but I make this decision based on what I see happening between the mother baby dyad. I have worked with numerous moms in the early post partum period who struggle with getting their babies to latch.  I have also been doing this job for a long enough time to know pretty quickly after observing a mother try and latch her baby, if it’s going to work or become a futile effort. If I can tell that a mother is getting so frustrated to the point where she is ready to throw the towel in before her baby is even a few days old, I might make the decision to introduce a shield to provide her with some hope so that she can see there is a real chance her baby can latch and breastfeed.

In the first few days, the baby may not actually drink any colostrum through the shield as it is quite thick and flows pretty slowly. But I do believe that sustained sucking on the breast with a shield is better than nothing. If it is going to put a smile on mom’s face, and encourage her to continue putting her baby to the breast, then I feel it is an allowable thing to introduce. I always get mom to pump/hand express after feeds and offer colostrum to ensure baby is getting enough to eat. Sometimes formula is also introduced and a feeding plan is created. The bottom line is always, BABY HAS TO EAT. But if I can help make a mom’s breastfeeding journey a bit smoother by giving her the opportunity to see that her baby can latch, then a shield is a useful tool in my humble opinion.

Anytime a mother is using a nipple shield, she needs to continue pumping after most feeds to ensure that her supply is ‘protected’. The baby’s weight should also be monitored weekly to ensure that adequate weight gain is taking place. I also encourage my mom’s to use breast compression when using a shield. This involves rhythmically squeezing the breast for 5-6 seconds at a time to help the milk to flow more readily. Compression should only take place when the baby is not swallowing milk. Of course if a mom has oversupply and her milk is flowing quickly, this technique should not be used.  Yes, it is a lot of work when using a shield, but it can also be very rewarding and for some mothers, this is the only way they can get their babies to breastfeed.

There are some drawbacks to using a nipple shield. I find that when shields are being used, the amount of time it takes a baby to breastfeed can increase. Sometimes the feeds aren’t always as efficient as there is a barrier between baby and the breast (this is why breast compression comes in handy). Sometimes a baby will still require a supplement after breastfeeding with a nipple shield. If a mom has an overabundant supply and her milk flows quite quickly, this isn’t generally the case.  I find it helpful to test weigh these babies a few times weekly for a couple of weeks just to ensure they are feeding efficiently and gaining weight appropriately. This involves weighing the baby before and after she feeds to see how much milk she is drinking from the breast.

Another drawback is that some babies get quite dependent on the shield. I find this is more the case with premature babies who are usually introduced to a bottle before they get proficient with breastfeeding. These little peeps get used to a longer, harder, silicone-type feel on their palates in order to stimulate their suck reflex. Shields are used quite routinely and with much success in the NICU but these are the babies that tend to get more dependent on a shield. This is why I encourage all moms using shields to always offer the bare breast first so babies ‘remember’ what it feels like in their mouths. These babies also require more pronounced areolar shaping and nipple tipping so they feel mom’s nipple on the roof of their mouths to stimulate the suck reflex.

My babies were not premature and I used a shield with my first and third daughters (not for very long….maybe a few weeks here and there). If it weren’t for the shield I probably would not have continued breastfeeding.  Luckily, I was able to wean them off of it without any trouble and we managed to continue breastfeeding without incident.

So my advice to all you breastfeeding mommies out there is to get in touch with an Internationally Board Certified Lactation Consultant (IBCLC) sooner than later if you are experiencing any kind of latching issue. These issues are super important to figure out in the early days of breastfeeding. Sometimes a nipple shield is useful and necessary to ensure that your little one breastfeeds. Again, any time a shield is used, it needs to be under the guidance of an IBCLC and your milk supply and baby’s weight gain need to be monitored closely for the first few weeks.

I hope you have found this blog helpful and informative.  As always, I am open to questions, comments, or concerns.

Happy Breastfeeding!!!!

Leanne Rzepa RN BN IBCLC

 

Posted on February 1, 2016 .