By Adrienne Koznek, IBCLC
The use of nipple shield dates back 500 years. They have evolved from being made of metal or wood to thick rubber, and most recently, to medical grade silicone. Historically, the older models showed to have a detrimental effect on milk supply in mothers, likely due to decreased stimulation of the nipple. While the use of nipple shields does indeed have drawbacks, recent research shows that they can in fact be a useful tool in aiding milk transfer in preterm babies.
The key aspect of nipple shield usage is ensuring it fits correctly. This is necessary to ensure proper milk transfer and stimulation, as well as to avoid any discomfort or damage. I highly advise only using a nipple shield under the supervision of a skilled International Board Certified Lactation Consultant. An article in Journal of Midwifery and Women’s Health recommends a size 20 mm shield for preterm babies, as that is the ideal size for their mouths. The authors of this article also assert that nipple shields can compensate for the preterm infant’s ability to suck strongly, as well as their tendency to fall asleep during feedings. Plans for use of nipple shields should be temporary in nature – an exit strategy is key!
For optimal fitting, turn the shield almost inside out and place it on the nipple to draw in as much as possible. It is also important to place the nipple shield with your breast in its natural position to avoid loosening of the shield when you move.
Another important aspect of using a nipple shield is ensuring a proper latch. It is necessary for the infant to have a deep latch and not simply suck on the end of the nipple shield. This will lower the risk of complications of transitioning to the bare breast – including a shallow latch, which can often lead to nipple pain and damage. With guidance and support, a deep latch can still be obtained with the use of a nipple shield. Even when using the shield, the basics of latch still remain: hold the infant tummy to tummy, and point the infant’s nose to the mother’s nipple. The chin should be buried into the mother’s breast when pulled close. Waiting for a wide gape and then pulling the infant in closely will ensure a proper latch. It’s important to be patient with this process; waiting for the infant to open wide can take time.
Nipple shields are commonly recommended for women with flat or inverted nipples, which can potentially cause difficulties with latch. While these variations in anatomy can pose some difficulties, a nipple shield may not necessarily be required. Some nipples may evert on their own simply from breastfeeding and/or pumping. It’s difficult to know exactly what your nipple may be capable of until they are put to use. Other uses for nipple shields may include, as previously mentioned, aiding in milk transfer in preterm infants; to protect damaged nipples while the mother works on the causes of said damage; to slow the flow of milk; or to aid in the transition from bottle to breast.
The popularity of nipple shields among breastfeeding women, along with their accessibility – they are located with the breastfeeding items at retailers such as Target and Walmart – leads one to think that nipple shield usage is commonplace and casual. However, what works for one mother may not work for another, and may in fact hinder the breastfeeding relationship. Many breastfeeding issues can be resolved without the use of a nipple shield. However, when used correctly and with supervision, a nipple shield can make a remarkable difference in a breastfeeding relationship as a temporary measure.
Not sure if a nipple shield will help you? Schedule with Adrienne here or come in to our wednesday Drop In Lactation help on Wednesdays from 10-11 am.