When The Doctor and Daughter asked me to write an article for their website it didn’t take me long to decide that what I would most like to discuss is nipple shields!
When breastfeeding goes well no artificial aids are needed, but as many mothers discover, breastfeeding isn’t always as easy as everyone makes out. Nipple shields can be the miracle answer for a whole variety of breastfeeding problems, but sadly too few mothers discover how brilliant they can be.
This is largely due to the fact that many (but thankfully not all) health professionals and breastfeeding counsellors are totally opposed to the use of nipple shields and will therefore never discuss how or when they can be used. The ones that are anti nipple shields take the view that nipple shields should never be used because they will always create “nipple confusion”, which will immediately cause a baby to lose his ability to suck correctly on the breast. They also tell mothers that using a shield will always reduce their milk supply as their breasts will not be as fully stimulated and emptied as they would be with “normal” breastfeeding.
Whilst I would agree that nipple shields are not suitable for everyone, this is no reason to prevent them ever being tried. As I said before, they do work really well for many mothers and are always worth trying if all else fails.
Read on to see why I disagree that they can never be used, how to use them and what problems they might help…..
1. Nipple/teat confusion.
In the Third Edition of their excellent book “Successful Breastfeeding” The Royal College of Midwives (RCM) discuss alternative methods of feeding a baby if “he needs to be given his mother’s milk by some means other than directly from the breast”. They say that Baby Friendly Hospitals should encourage the use of cups or syringes for “one or two feeds if given to very young babies who only need small amounts”, but they say that “for longer-term use, a feeding bottle is quicker and less wasteful than cup feeding and is usually more acceptable to the mother”. They also state, “There is currently concern that if a baby feeds from a bottle he will somehow not be able to feed from a breast. This is often referred to as ‘nipple confusion’. There is no evidence to support this concern”.
Despite this clear statement from the RCM (maybe they have now changed their mind?), many mothers are still being told that they will never be able to establish breastfeeding if a bottle or a nipple shield is used even once. As you can imagine these mothers are pretty distraught, but I am happy to say that I am nearly always able to show them that their baby is still perfectly capable of breastfeeding even if he has had several days or even weeks of being fed via nipple shields or bottles. In the vast majority of cases it is just a question of showing the mother how to shape her breast (as discussed in all my books) to make it easier for the baby to latch on. A correct latch will nearly always instantly resolve the problem of sore nipples as well.
2. Reduction of milk supply.
In their book ‘Successful Breastfeeding’ the RCM warns that shields “may lead to a conditioned rejection of the breast by the baby” and that “prolonged use may also adversely affect the mother’s milk supply”. But they go on to say that “clinical experience suggests that some mothers may benefit from the judicious use of a thin silicone nipple shield”. I am in full agreement with the RCM in that nipple shields might have an adverse affect on breastfeeding, but that is not to say that they can never be used. You only have to meet one mother who was able to use shields for months on end without any detrimental effect on her milk supply to realise that nipple shields can work perfectly for some mothers.
Because it is undoubtedly true that nipple shields will not work for everyone, each mother must experiment for herself to see whether they will work for her. In general, I find that nipple shields work really well if a mother has plenty of milk which flows quickly, but if she has a poor supply of milk and/or a slow let-down the baby will usually struggle to get enough milk through the shield and she cannot (and should not) continue to use one.
Many breastfeeding problems (see below) can be helped by using nipple shields, but you need to work out how to use them and check that your baby can feed properly via the shield before relying on them as the solution to all your breastfeeding problems.
These are my guidelines:-
- A baby will not be able to get colostrum through the shield so a shield should not be used until the mother’s milk comes in.
- Nipple shields come in several different sizes and it is important to use the one that best suits your baby. The size of the nipple shield is dependent on the size of the baby’s mouth, rather than the size of the mother’s nipples. If you put a large shield on a large nipple, this will usually make it even harder for the baby to latch on. The one I use most often is a small or medium size shield made by Medela.
- Place the shield over your nipple and then latch your baby on quickly. If you bring him too slowly to the breast or don’t hold him in close enough he will keep knocking the shield off and he won’t be able to feed properly. He should be held in so closely that both his nose and his chin are touching your breast.
- You will be able to tell whether he is getting the milk properly through the shield by the way he sucks. He should start off by doing some very quick sucks to stimulate your let-down. Then, if the milk starts flowing freely you will notice that he suddenly changes to slow, deep and rhythmic sucking. You might also hear him swallowing.
- You can also check how well he is feeding by taking him off after a few minutes of sucking to see what is happening. If there is a pool of milk at the end of the shield he will be getting the milk easily and you can continue to feed him through the shield. But if there is little or no milk visible it is likely (but not absolutely certain) that the milk is not flowing freely and he may be unable to get a full feed through the shield.
- Ultimately, your best guide as to success or failure when using nipple shields is to see how long your baby feeds and how well he settles after each feed – the quicker he feeds and the longer he lasts in between feeds, the better the shields are working.
- If feeds gradually become longer, or your baby is not settling after feeds (because he is still hungry) and/or you notice that your milk supply is reducing, you should stop using the shields.
Providing your baby is easily able to get milk through a shield, you can try using one for any of the following problems:-
1. Difficulty in latching onto large or flat nipples
Some mothers, who have a combination of large nipples and a small baby, might find latching on extremely difficult. Shaping the breast (as described in my books) will usually resolve this problem, but sometimes the mother is a bit uncoordinated and can’t manage the technique and sometimes the baby really can’t get his small mouth onto a Jordan size breast! In these cases, a nipple shield provides something the baby can get hold of and he will feed from the breast in the same way that he will feed from a bottle.
2. Primary Engorgement
When the milk first comes in, breasts can sometimes become so hard and engorged that the baby simply can’t latch on. In this situation, mothers are usually advised to express some milk to soften the breasts and make it easier for the baby to latch on. This works well but it is time consuming and also involves sterilising pumps and bottles. A quicker and easier solution is to use a nipple shield for the first few minutes, as this will enable the baby to get the milk easily without the need for expressing.
If your baby has a mild tongue-tie and can’t suck properly on the breast, a nipple shield will usually make feeding easier for him. But if he has severe tongue-tie it is better to get it cut than to rely on shields to help him feed.
4. Babies who can latch on perfectly well but will not suck on the breast
A small number of babies seem to have a very poor sucking reflex. These babies will often latch onto the breast perfectly but then do absolutely nothing! They either fall asleep without doing any sucking, or they start crying and pulling away from the breast. I don’t know why they do this, but all I do know is that some of these babies will start sucking properly if you use a shield. I can only presume that a soft nipple doesn’t provide the same stimulation as a harder nipple shield. With these babies, you may only need to use the shields for a few feeds, or you may find that it takes many weeks before the baby is able to suck directly from the breast.
5. When the mother’s milk flow is too fast
Some mothers have such a fast flow of milk that the baby simply can’t cope with the rush of milk. These babies will typically suck at the breast for a very short time and then start gulping and choking on the milk. If the baby then pulls away crying and appearing distressed, he is almost certainly being frightened by the sheer speed at which the milk is flowing and he will probably get more and more panicky with each subsequent feed. If this happens, a shield will usually solve the problem immediately, by slowing and containing the flow of milk so the baby can feed at his own pace.
6. Sore nipples
I rarely use shields for this reason, as better positioning of the baby at the breast will nearly always solve the problem instantly. But if you can’t find anyone to help you improve your technique, it is better to try using a shield than to carry on suffering or even to give up breastfeeding altogether.
How long can/should I use them for?
The short answer is: for as long as you need them and for as long as they continue to work well ie. the baby is getting plenty of milk and feeds are not taking too long. But it is still worth making the point that many mothers would not need nipple shields at all if they were able to find a health professional who is able to show them how to feed successfully without shields. As in any occupation, some people are better at their jobs than others so it is worth asking your friends for personal recommendations of a good breastfeeding counsellor in your area who has a reputation for solving problems rather than just offering continued to support.
So, to sum up, I would urge all mothers and health professionals to try using nipple shields if the need arises. If you are prepared to keep an open mind and listen to mothers who have successfully used a shield, it will become apparent that it really can work extremely well in many cases.
Here is an example of a closed mind: A client rang to tell me how hostile her health visitor had become on hearing that she was using a nipple shield to reduce the fast flow of her milk. Despite that fact that the mother was still breastfeeding at 4 months and her baby was gaining weight, the health visitor still insisted that she shouldn’t use one because ‘it will cause nipple confusion and reduce your milk supply’. Talk about not looking at the evidence…!
Clare Byam-Cook SRN SCM
Author of ‘What to expect when You’re Breastfeeding…and What if you Can’t?’
You may also like to read
This brilliant article by Charlotte Young, IBCLC “How to Prevent and Treat Sore Nipples”
Also by Charlotte Young, IBCLC “Mixing Bottle and Breast, it doesn’t have to be all or nothing”
By Hanna Rosin “The Case Against Breastfeeding”