Nipple shields: Creating another win-win for mother and baby!

If I were given a dollar every time someone said to me “I know I’m doing the wrong thing but I’m using a nipple shield,” I would be a wealthy woman.

Who says a mother can’t use a nipple shield? How dare anyone say to a mother who happily and painlessly breastfeeds that she should stop using one. Whose nipples are they? They sure as hell ain’t the midwife’s or the community nurse’s!

How about “Congratulations, you are breastfeeding, great job!” Then and only then, ask: “Out of interest, how do you find the shield useful?” I am fed up with countering the damaging advice given by ‘professionals’ telling clients I see that they shouldn’t use a nipple shield as it can reduce their supply and cause nipple confusion.

My immediate response is “don’t stop using it until I see you”.

As professionals, our goal is to protect breastfeeding, however a mother does so that works best for her.

Using a nipple shield and breastfeeding? Fantastic! Well done! Congratulations!

Lose the nipple shield and give up breastfeeding? That’s a win? I think not.

Occasionally a new mother may misunderstand that using a nipple shield incorrectly and using the wrong size will fix her grazed and damaged nipples. Generally, I find mothers who are using them have a genuine need for a correctly sized nipple shield to help them feed successfully and longer. Who can argue with that?

Let’s look at why a mother might need or want to use a nipple shield:

1. Baby has a tongue or lip tie that may need to be snipped.
2. Mum has smooth nipples that only surgery can fix and the baby has no chance of adequately drawing the nipple correctly into his mouth.
3. Baby (usually premature) has a small mouth and needs time to grow into his mother’s nipples while they are temporarily too broad or big for him to draw in comfortably and correctly into his mouth.
   Nipple vasospasm can cause tremendous pain and can take time to treat and manage (and sometimes the interventions don’t work).
4. Women don’t like the feeling of the baby on their nipples but can tolerate the shield.
5. The opinion that “research says you will lose your supply by 20% when you use a nipple shield” is simply an old wives’ tale. It immediately discredits the person who has said it. The ‘research’ mentioned was done on very old, long, thick nipple shields that shouldn’t be used or even be in the bottom of any pharmacist’s shelf!

In conjunction with a well chosen silicone shield (and some are badly designed) that fits a mother’s nipples correctly and comfortably, a breastfeed should be supervised to ensure attachment and positioning is painless, good milk transfer is noted, baby feeds effectively, and the breast is soft and comfortable at the end of the feed.

I’m not a fan of the idea that a mother should express after a feed if her milk hasn’t ‘come in’ because I believe that the more she feeds frequently and comfortably with a nipple shield, the sooner her ‘milk will come in’. I’m always keen to encourage lots of skin to skin contact so that anytime the baby stirs, the sooner and more frequently he will breastfeed painlessly using a shield.

I have supported enough mothers in the early days with this approach and have never had a mother who didn’t have her milk come in or in fact ever lose her milk because she used a nipple shield.

I feel the more we add ‘conditions’ to the use of nipple shields along with the inconsistency of help and support as to how a mother ‘should’ feed and express with smooth or inverted nipples in the early days after birth, the greater the potential there is for her to feel ‘a failure’ and want to give up. Again, I have seen this happen on enough occasions to feel confident predicting more unhappy and unsuccessful outcomes than positive breastfeeding outcomes.

I do, however, think there are necessities when helping a mother use a nipple shield:

1. Mothers need to understand that the shield is not the cure-all for cracked or damaged nipples. In the majority of cases, refining how a mother positions and attaches the baby to the breast is the answer.
2. Once identified that the shield could be useful, a good fit that comfortably accommodates the width of the mother’s nipple and not the size of the baby’s mouth is essential. (Unfortunately I can’t name names but some brands just should not be allowed to make shields as they are too narrow or too long risking the mother experiencing pain and her milk supply).
3. Supervising a feed is essential to be sure the mother is not experiencing pain or discomfort using the shield as well as watching and listening to the baby sucking and swallowing effectively with the shield.
4. A follow up appointment to watch a feed should be made to ensure the baby is breastfeeding effectively and the mother’s milk supply is meeting her baby’s needs.
5. I recommend nipple shields frequently and see mothers breastfeed long term, because they help! Mothers don’t need to be challenged about a shield but rather supported in their need to use one. When feeding has settled down and mothers are confident trying a feed without the shield, I think we can trust them to do so without undue pressure from us to get rid of the shield. It may take a little while for some babies to transfer to their mother’s natural nipple but again, I have never seen this as a problem or had anyone complain of ‘nipple confusion’ (another topic for another blog!).

If the ongoing use of a nipple shield maintains a breastfeeding relationship that would have otherwise broken down, then a win-win outcome has been achieved for a mother and her baby.

Happy breastfeeding week and Go Mothers! – however you provide breastmilk to your babies.