A Heartfelt Latch – What You Need To Know

by Jessica Martin-Weber

This post is generously made possible by Bamboobies

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That moment when they’re finally in your arms and you can count fingers and toes and sniff their head and stroke the softest cheek you’ve ever felt in your life, that moment is, whether you can feel it right then or not, when you heart is captured forever. Suddenly everything this little person needs from you, you are ready to do with all your heart. Comfort them, change them, bathe them, sing to them, and feed them, simple yet profound tasks of care are heartfelt acts of love.

No matter how your feeding journey unfolds, there is no doubt that every moment is fueled by love. Even if it is stressful at times. But it does help to know some of what you can expect, how things may unfold, and what you should know going into it. Love may be all you need but love with information and support is just so much more… well, lovely.

There’s a lot of information so we’re just latching onto one little tidbit for now here: the latch.

If you’re breastfeeding or planning to, you’ve probably heard a lot about the importance of a “good latch.” For some, that can create some anxiety about getting that good latch and a sense that doing so can be elusive so we wanted to help break it down a bit with 3 need-to-know tips about a breastfeeding baby’s latch.

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  1. If it ain’t broke, don’t fix it.

Many of us want manuals for everything, how-to guides so we avoid making mistakes and pursue the elusive perfection. You’ll find all kinds of diagrams, pictures, and descriptions of what constitutes a “good” latch. Step 1, step 2, step 3 and if you follow them exactly, voila! The thing is, that’s very rarely how it works with human beings, not even textbook babies.

It is really very simple: if it’s comfortable and it’s working, it’s a good latch.

If it isn’t comfortable and it isn’t working well, then it may not be a good latch.

Baby has plenty of wet diapers? Gaining weight? Good signs!

Baby has low wet diaper count? Difficulty gaining weight? Hmmm, not so good signs.

Mommy can feel her breasts soften a little with baby at the breast? Nipples doing well? Good signs!

Mommy has pain beyond initial latch through the feed? Nipple damage? Not so good signs.

There is a real possibility that your baby’s latch won’t look like the textbook “good latch”, there may even be clicking (though I’d get that checked out just in case anyway), but if it is working for you both then it’s not a good latch, it’s a great one!

A good latch is one that works for mom and baby!

  1. It’s a team effort.

Mom and baby make a dyad, a new team, and they have to work together. Which can be tricky since you barely know each other. But you also know each other better than anyone else. Working together can seem really complicated but don’t borrow trouble and remember that you’re both equipped to do this.

Given that one of the team hasn’t been around too long, that can get tricky sometimes, especially if there are other obstacles in the way such as jaundice.

What team work looks like in achieving that latch of your dreams:

Mom is in a comfortable position and has brought the baby to her level to her instead of leaning down to the baby.

Baby has wide open mouth.

Baby’s body is facing yours.

Chin will touch the breast, nose will be unobstructed, lips will be flared like a flange around the nipple taking in as much of the areola as possible.

Hold baby securely, a snug, close hold will help.

Pull baby in quickly when mouth is open wide.

If you can relax, try leaning back on some pillow, work together, and remember that first rule, it may all just surprise you.

If your baby is not able to do their part of the teamwork, it is time to seek out the support of a health care professional. Speaking with an IBCLC and your child’s pediatrician to identify the cause and options early can go a long way in getting on track to reach your breastfeeding goals.

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  1. If you’re hurting or even just worried, ask for help.

Once upon a time women feeding their babies was visible in our communities and while we’re shifting that way now thanks to the global village of the internet, we still don’t really see it regularly and not all that up close and personal. This has led to us entering our baby care days without much of an idea of what’s normal and even when to ask for help. In fact, it can be easy to start thinking we shouldn’t ever ask for help.

Can you imagine telling your child some day that their nipples may be in agony but they shouldn’t ask for help? Of course not! That would be cruel.

Thankfully, between the internet, hopefully some in-real-life friends, and health care providers, more and more we have resources to help us find our way. Ask in forums, watch videos (this “flipple technique” is helpful for correcting some common latch problems), and read resources (like this one and this other one).

If you’re experiencing anything more than an initial twinge of pain with breastfeeding your baby it may be a sign that something is wrong. Not that you’re doing something wrong or have somehow failed, but rather pain can be a common sign of a problem that with support may be able to be corrected. (There are some conditions that will lead to regular pain in breastfeeding such as Raynaud’s phenomenon.)  It is possible that a painful latch, a baby with too few wet or soiled diapers, low weight gain for baby, stabbing or burning feeling in the breast, or a fussy baby at the breast in combination with any of these issues could be an indicator that there is some problem to address. From tongue and/or lip tie to high palate to jaundice to any number of reasons that a mom and baby dyad would be experiencing difficulty, seeing an IBCLC (International Board Certified Lactation Consultant) can help bring things together and set you and your team mate well on your way to reaching your breastfeeding goals.

And then you can get back to doing what you do best, holding them close to your heart and loving them completely.

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What helped you get a good latch?

Leave a comment below! We’d love to hear how you figured out what was best for you and your baby.

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Jessica Martin-Weber

Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, and creator and author of the children’s book and community of What Love Tastes Like, supporter of A Girl With A View, and co-founder of Milk: An Infant Feeding Conference. She co-parents her 6 daughters with her husband of 19 years and is currently writing her first creative non-fiction book.
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Dear Kathleen- on nipple damage healing and pumping

We receive hundreds of emails and messages daily from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past few weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

My nipples are a wreck following a shallow latch and then thrush with my 8 week old.  After working with an IBCLC that helped fix my daughter’s latch and take care of the thrush, things are improving.  However, my nipples are still cracked and bleeding and I think they just need a break to heal.  The IBCLC I work with suggested I just pump for a little bit until I’m healed and I’m ok with that.  I feel like I’m a bit lacking in the pumping department though and only got 4 ounces the first time I tried with a hospital grade double electric pump and my daughter downed that pretty quickly.  How often should I be pumping to keep up my supply?  How long should I expect healing to take?  How do I pick a bottle that won’t encourage my daughter to prefer the bottle over me?

Thank you so much for your help!

Sore Nipples 

 

Hello Sore Nipples!  I am so sorry to hear that you are still struggling at this point in time! Sounds like you have been through a rough go.  Yes, you and your L.C. are on the right track.  A break from any more trauma is certainly in order.  I am happy to hear that you have a clinical grade pump.  I do hope you have the right size flanges for more comfortable pumpings and for removing the most amount of milk possible.  If your nipples are swelling very much in the tunnel, I would suggest getting the next size flange for more comfortable and effective pumping. Another product, “Pumping Pals”, slipped into any flange, makes pumping even more comfortable and for some moms even more efficient.  You might want to visit their website to see what I mean.  The company is very helpful in getting you the right size flanges to use in your kit and they are fairly inexpensive. With that being said, still many pumps still leave quite a bit of milk on the breast.  For that reason, I suggest “Hands-on Pumping”, that is using your hands to help remove the most milk possible at each pumping.  Please watch Dr. Jane Morton on Stanford University’s website on breastfeeding issue and see her mini-lecture and video of hands-on pumping.

I would like to talk to you more about the condition of your nipples.  If your nipples are still cracked, I would like you to consider treating them with an oral antibiotic.  Mothers with injured nipples longer than 5 days are at a much greater risk of developing mastitis; 75% of moms with open nipples go on the develop a breast infection because of the bacteria in the open areas.  And this seems much more common during the cold weather months.  There was a great study done by two Canadian physicians some time ago that showed the consequences of wounded nipples that were untreated leading to mastitis.  Also, nipples are more difficult to heal when they are infected with bacteria.  For both of those reasons, I suggest speaking with your midwife or doctor about getting treatment for at least 10-14 days.  I don’t think most doctors are aware of this connection, but with your nipples being in this shape so late in the game, I am convinced they are colonized with bacteria.  Yes, I am sure that this makes you worry about yeast, but yeast is much easier to treat than a case of mastitis, which can also lessen your overall milk production.

Mastitis risk with damaged nipples

I do think that getting 4 ounces is about what a baby at this age requires at each feeding.  You will want to aim for about 8 pumpings each 24 hours.  If you are not getting at least 3-4 ounces when you pump, you may want to also consider using some herbs.  You can use fenugreek capsules that are available at most any health food store, 3 caps three times a day. This is probably different that the dose given on the bottle.  I actually find that mothers do quite well using Mother Love’s More Milk Plus, a combination of milk stimulating herbs.  You can visit their website and see if there is a local distributor or order them on-line directly from Mother Love. Nursing teas are a very weak form of any herb, so I don’t recommend them as the primary way to stimulate higher milk production.

Babies typically down a bottle in no time flat and may still act hungry!  This can lead parents to believe that the baby may need more milk.  Four ounces with a slow flow nipple, might help some but keep in mind that many nipples that are labeled as slow flow, really aren’t!  Hopefully, the baby takes 5-10 minutes to drink 4 ounces of milk. There is an old saying, “It takes 20 minutes for the brain to know when the stomach is full!”  So true!  If you are very worried that the baby will come to fall in love with the bottle flow, you might reconsider and have one nursing every 24 hours, but I leave that to your discretion. I think for most babies, if there is a healthy supply of milk, they should return to the breast without too much of a problem.

I wish you every success and very soon!  You are quite a determined mom!

Best wishes,

Kathleen

Kathleen-HigginsKathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  
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In Search of the perfect latch

Sugarbaby 1 week old. Photo by Kelli Elizabeth Photography

“I’m really scared of breastfeeding.”  Pregnant with her first my friend subconsciously rubbed her 34 week belly as I made dinner and we chatted.  Puzzled, I asked her why.  She said she googled and learned that it can be so painful, particularly if they don’t have a good latch.

“How do you get a good latch?” she asked me.  She went on to explain that she had read different blogs and forums about how hard it was to get a good latch, women with bleeding nipples, and babies not gaining weight.  She wondered what was the secret to a good latch and what if it didn’t happen for her.  It’s true that these issues do happen and probably far too often but here she was, weeks away from having her little baby, scheduled to take a breastfeeding class in the next couple of weeks, and worried that she was facing a world of pain if she couldn’t get this elusive latch and not find the secret for it ever to happen.

Earlier that same day I had coffee with a good friend, an IBCLC at a local hospital.  The topic of the elusive perfect latch came up and she surprised me by telling me that she thinks we make too big deal about the latch.

“If mom isn’t in pain and baby has plenty of soiled and wet diapers, why do we need to mess with anything?  Sure, if there’s a problem such as pain or a dehydrated baby then we need to fix what we can but so what if that bottom lip is curled in if it’s not bothering anything.”

In other words, if it’s comfortable and it’s working, it’s a good latch.  There is a wide range of normal.

I love this woman, she often says exactly what I’m thinking.

In general, if everything is working right, babies are ready to breastfeed and mom’s breasts are ready to feed.  It just works and we really don’t need to mess with it, it doesn’t have to be this complicated endeavor.  Maybe it will be difficult but we don’t have to expect trouble.  More often than not moms need support simply because breastfeeding isn’t so common in our society and women don’t see breastfeeding as a part of normal life making the learning curve steeper than it would be if seeing breastfeeding was commonplace.  There would be less stressing about the perfect latch if more women saw what it looks like when a baby is at the breast as they go about daily life.  Their moms, sisters, aunts, friends, coworkers, or even strangers breastfeeding would have already demonstrated a baby feeding well.  The wide range of normal would be seen and experienced.  Today a woman may never see another woman breastfeeding until she’s feeding her own baby for the first time.  Seeking out support she may look online or join a breastfeeding support group, seeing breastfeeding dyads in a very specific setting that she had to find.  If she is experiencing difficulty with pain or ineffective milk transfer for her baby, because she hasn’t been exposed to breastfeeding pairs, she may not even realize that the way her baby is latched could be what’s causing the problem or that it may even be a fairly simple fix.  When there are issues such as poor weight gain for baby or bleeding nipples the first thing to consider is a poor latch.  After I shared a few pictures of Sugarbaby’s latch on Facebook, there were several comments and I received several emails from moms stating that they never knew saw what a latch looked like and had endured pain in breastfeeding because they didn’t realize something was wrong.  Side note: if you are ever experiencing pain with breastfeeding that is more than a brief moment of discomfort or lasts beyond initial latch please seek out help, pain is usually an indication of a problem than can be corrected.  This doesn’t mean you’re doing something wrong, it just means you probably need help.

 I talked with my friend Star Rodriguez, IBCLC of Lactastic Services and WIC peer counselor for the following lists.

When do you need to consider latch issues and improving your nursling’s latch?

  •  When breastfeeding is painful beyond the initial latching.
  • When there is tissue damage to your nipples.
  • When there are weight gain issues for the baby.

What latch pointers can moms try?

  • Mom is in a comfortable position and has brought the baby to her level to her instead of leaning down to the baby.
  • Baby has wide open mouth.
  • Baby’s body is facing yours and baby’s arms are not pushing away at you.
  • It is best to let the breast fall naturally if possible.
  • If large breasted or when milk first comes in, it may be helpful to hold your breast with your hand.
  • Aim baby’s nose toward the nipple; if necessary to encourage a wider mouth, tickle the very top of the baby’s upper lip with your nipple.
  • Latch should be asymmetrical. Chin will touch the breast, nose will be unobstructed. You do not need to push your breast away from your baby’s nose in a good latch.
  • You will hear or see baby swallowing – short sucks/swallows at first, longer ones as milk starts to let down.
  • If using a nipple shield, ensure that the nipple and surrounding tissue is being pulled into the shield.

What can a mom do to try to improve a painful or ineffective latch?

  • If baby isn’t opening mouth wide enough, attempt to show baby by opening your own mouth wide.  Many babies will subconsciously mimic this.
  • Make a “breastwich” with your hand in the shape of a C behind the areola to help baby get a bigger mouthful.
  • Get baby as naked as possible for skin-to-skin or lightly dressed.
  • Hold baby securely, a snug, close hold will help.
  • Pull baby in quickly when mouth is open wide.
  • It is common to experience some discomfort at latch in the first few weeks of breastfeeding.  It should go away as the feeding continues.  If it does not end after around 30 seconds, you may need to remove the baby from the breast and reposition the baby.  Break the suction by placing your little finger into the corner of the baby’s mouth and trying to latch again.  Some lactation consultants can show you ways to fix a latch without taking the baby off the breast, but those are easier to learn from being shown rather than told.  You may need to put the baby in a different nursing hold or position.

When should a lactation consultant be called?

  • Repositioning doesn’t work
  • If there is sudden soreness after there has been painless nursing
  • If you feel stabbing or burning pain in breasts or at latch
  • If you have cracked or bleeding nipples
  • If your latch is not painful but your baby is not having a good amount of wet and dirty diapers

Check out these other resources on latch:

11 Common Pitfalls When Latching a Newborn

 

Latching and positioning resources

Latching: Thoughts on Pressing Baby’s chin down

 The Mother-Baby Dance

 

Coming soon a photo gallery of latched on babies and their mother’s commentaries on their latch experience illustrating the wide range of normal and potentially problematic latches. 

 

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Nipple confusion, bottles, and alternative feeding options

On January 17, 2012 in the United States, Medela, best known for their pumps, launched their latest “feeding innovation”, the Calma.  The Calma is a bottle that seeks to eliminate nipple confusion and flow preference by making a bottle fed baby work for its milk, similar to how your little one must compress and suck at your breast to get milk out.  According to Medela, this “supports an easy transition from the breast to the teat and back.”

As a registered International board certified lactation consultant, I am very skeptical of these claims.

I have often heard that nipple confusion is a myth, foisted on mothers to keep them stuck to their brand new babies, to keep them from leaving the house, to subjugate us all.  This is simply not true.  Nipple confusion happens.  I have seen numerous cases of it in my practice.  Babies become nipple confused for three reasons – flow preference, difference in movements, and difference in feel.  Medela has the right idea on part of the equation.  Babies that are given a lot of bottles in the early period can decide that it’s not that fun to work a breast when this plastic thingy is way easier.  Most bottles, even the slowest flowing, flow faster than milk from a breast.  However, your baby also moves their mouth differently to get the milk from a bottle than from a breast.  The jaw and tongue movements are not even close to the same, and trying to transfer the movements from one to another can frustrate and upset your baby.  After all, if your baby is new, this whole eating thing is new, too.  Why complicate it?  There’s a bonus too: a baby nursing at the breast will develop their mouth in a way that will help with prettier smiles and better speech, too!

The third part of the equation is the different feel.  If you are giving your baby a softer breast and a harder silicone, they may very well like the way that a bottle feels more – especially since that silicone is, again, delivering milk faster and the mouth movements are different.   Medela hasn’t really done anything to cure that.  I’ve seen and felt the Calma, and, I assure you, it will not be mistaken for breast tissue anytime soon.

The easiest way to prevent nipple confusion is by waiting to introduce a bottle until four to six weeks (three to four at the earliest) and to simply offer the breast more than the bottle.  Some families have other situations, though, that don’t make the whole four to six week thing possible.  So what is a modern mom to do?  For many of us, it is not feasible to never give milk from anywhere but the breast.  We have work, and school, and other children, and obligations, and, man, sometimes Mommy just needs a day (or an hour or two) off.   But babies still have to eat during that time!  And what if your baby has issues with latching at the breast, or you are inducing a supply, or you need to do some supplementing?

Luckily, being a modern mom means that we have some awesome options available to us.  There is spoon feeding, where you can hand express colostrum or milk directly into a spoon and give it to your baby.  This works best in the beginning, when your baby isn’t taking in much milk yet – it would be a fairly long process for a family feeding an older infant.  To spoon feed, you simply use a clean spoon, hold the baby in an upright position (like sitting) and put the spoon at the lower lip, giving small amounts and letting the baby go at their own pace.  A spoonful can be considered a full feeding if you are dealing with a newborn.

Cup feeding is another option.  Cups are widely available, cheap, and easy to use.  Your infant won’t take the cup from your hands and drink like a big kid, of course, but will instead lap at the milk kind of like a baby animal might.  There are special cups sold for cup feeding, but it might be easier and cheaper to just use a shot glass.  With cup feeding, like spoon feeding, you’ll hold the baby supported and upright.  You’ll put the cup to the lips and tilt slightly so that the baby can easily lap at the milk (not so it’s pouring into his or her mouth.)  Allow the baby to eat at his or her own pace.  It may take a while, but that is ok!  Babies shouldn’t be gulping down their feeds – when they do, they often overeat, which can hurt their tummies and set a bad precedence of wanting more than they need.

You can also use what’s called a supplemental nursing system, or SNS.  SNSs are generally a bottle type thing hooked to a long tube.  You put the milk in the bottle part, and then you can do one of two things with the tube.  First, you can use it on the breast, either by sticking it in a nipple shield (which you should only use if followed by a lactation consultant for sizing and to negate any potential complications that might arise) or by taping the end near the nipple so that the baby gets an extra boost of liquid while nursing.  This can be really helpful if you’re relactating or increasing a milk supply, if your baby needs to be supplemented but is nursing well, or if you have a preemie or baby with suck issues that maybe doesn’t milk the breast as effectively as they should be.  You can also use a SNS to finger feed your baby.  With that, you attach the tube to your finger, and the baby sucks the finger to get the milk.  A lactation consultant can even help you use this method to train or retrain your baby to suck properly.  SNS systems can be hard to clean, so please carefully read the instructions and check with a health care provider for any extra precautions you should take if you have a preemie or immune compromised baby.

If you have an older baby (4 months or so) that’s just now getting around to taking milk in another way, you can try forgoing bottles altogether and working on cup training or using sippy cups.  Sometimes the difference is interesting enough for an older baby who has rejected bottles.  As with any of the other methods, the goal is to allow your baby to learn and go at their own pace.  Be prepared for this to be a messier endeavor with an older baby who is starting to show some independence.  You will probably have to help them to hold and tilt the cup – they may not be content with the idea of you holding it all yourself, and you may have some spills in the process.

But what if none of these methods work for you?  Maybe your care provider is balking, or you are annoyed and uncomfortable with one or all of the methods, and you really, really just want to use a bottle.  In that case, instead of purchasing the reportedly $15 a piece Calma, I would try Fleur at Nurtured Child’s method of baby-led bottlefeeding.  In fact, any time you are bottlefeeding, you should use this method.  It is the ideal way to feed a baby from a bottle and encourage any care-takers that will be feeding your baby with a bottle to utilize this method as well.  In choosing a bottle, there is no really good evidence that I have seen showing that a certain bottle or nipple is better than another for breastfeeding.  There are a lot of nipples that are supposed to be similar to your breast in look and feel, but in my time in the bottle aisle, I never saw any that made me go, “That looks EXACTLY like my boob.  That one, right there, with the wide base and medium sized nipple!!”  My kids never really liked the wide bottomed nipples, although they are often touted as being awesome for breastfeeding babies.  When it all boils down to it, most of that is hype.  When selecting a bottle, select the one you think might work that is in your budget.

If you are giving milk due to a breastfeeding problem, be sure to discuss methods and supplements with a medical professional with good lactation training.  Ask a lot of questions.  If supplements are ordered, get a LOT of information on them.  Why do you need to supplement?  How long does your medical professional want you to supplement?  How much should you supplement?  How often should you supplement?  Can you use your own expressed breast milk?  What is the plan of action for weaning from supplementing?  If your baby isn’t nursing well at the breast, you will likely need to do some pumping along with the supplementing to keep your supply healthy while you work through the problem.  Find out how often you need to pump and how you should store your breastmilk – especially if your baby is hospitalized and you are transporting it.

There are other feeding options for more serious problems, such as cleft lip/palate as well. That type of situation needs to be followed very closely by a lactation professional and physician to ensure that the baby’s unique situation is being addressed.

If you are going to be separated from your baby for another reason – work, school, or just going out – remember to think of your magic number.  This is the number of times your baby breastfeeds in a normal day (and, yes, that can vary.  Just take an average.)  You want to be sure that you are replicating that amount of times by a combination of pumping and nursing.  This will help to keep your milk supply plentiful.

In the end, there is no product on the market that can magically be just like your breast and provide your baby the exact same experience.  Luckily, there are many options for your baby and your family that will help you to achieve your breastfeeding goals.

 

 
 Star Rodriguiz, IBCLC, is a breastfeeding peer counselor for a WIC in the Midwest and has just started her private practice as an IBCLC (her Facebook page is here, go “like” for great support).  She also sits on the  breastfeeding task force in her town, is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.
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Nipple Shields- Q&A

by Deirdre McLary, IBCLC

Nipple shields can be a useful tool in breastfeeding when they are needed.  Knowing when and how to use them is important.  Here we take a look at some common questions about nipple shield use.

 

1. Who might need a nipple shield and will they know before their baby is born?

In both childbirth and breastfeeding I like to start out with a baseline of “normal”.  As women, we are made to do these things, and to do them well!  All babies and moms are capable of bonding right after birth, of getting off to a best start and of moving forward into a long lasting and complication free breastfeeding relationship.

For some women the support and knowledge is not always there and challenges present themselves early on.  This is why it is important for women to recognize potential breastfeeding problems while still pregnant, and to arm themselves with knowledge and support ahead of the game.

In my childbirth classes and prenatal breastfeeding classes I always recommend mom take a close look at her breasts and nipples in the privacy of her home.  Get to know your nipple shape and what to look for!  Are there any blemishes and moles that exist, are your nipples flat, inverted, particularly large or small in diameter, what is the shape of your breasts, are they symmetrical, have you had any surgical procedures that might affect breastfeeding?

Familiarize yourself prenatally with your anatomy so that when bigger breast changes come (when milk comes in) you can know what is normal for you vs. what might be new and surprising looking.

Most babies can successfully latch on to most nipple types.  Mother and baby are a perfect pair! A nipple shield should always be a last resource for a baby who will not latch for some reason.

The important thing to remember is that if a baby won’t latch or there are painful nipples, there are other things going on that an IBCLC or lactation consultant can help you with instead of turning to a nipple shield.

 

2. Do all women with flat or inverted nipples need nipple shields?

No.  Most just need support and resources for help.  “True” inverted nipples may cause complications due to adhesions at the base of the nipple that bind the skin to the underlying tissue.  There is a nipple “pinch” test that can help a mom determine if her flat or inverted nipples are “truly” inverted (with a true inverted nipple the nipple will retreat inward when pinched rather than protrude outward).

Most flat and inverted nipples do protrude with a little exercise and routine.  Some techniques are; pumping, Supple Cups (little thimble shaped devices that help “train” a nipple to protrude), stimulation, Hoffman exercises, (loosening skin and stretching the nipple by placing thumb & index finger on opposite sides of nipple base, then pressing inward, then pulling away) or breast shells.

 

3. What, in your opinion, is the most common unnecessary reason nipple shields are used?

Painful nipples or inexperience.  If your nipples are painful and getting a good latch is difficult, there is an underlying reason! Let’s get to the cause of it rather than cover it up with a tool that may only add to your problems.

 

4. What is the most common necessary reason nipple shields are used?

It can vary.  Each mother-baby pair is unique.  What applies to childbirth applies to breastfeeding – judicious use of intervention may be necessary and life saving if done appropriately.  Nipple shields are just another tool out there, and in my experience they should be a short-term solution and used under the guidance of an experienced IBCLC or lactation consultant.  There are real reasons to use one that may save a mom from having to turn to unwanted bottles and formula and may in fact help to preserve and support a long term breastfeeding relationship.  Used wisely they can be a very useful tool.

 

5. Tongue tie comes up often, are nipple shields a good way to handle
tongue tie?

The best way to handle a tongue tie is to have a thorough evaluation and seek advice on if a release procedure is appropriate or if perhaps a better course would be gentle body work by a reputable cranial sacral massage therapist.  After the referral out for support, if baby is still having difficulty latching – the same rules apply … “why” is the latch still poor?  What’s going on?  Let’s solve that riddle.  Using a nipple shield may be an appropriate, temporary, tool to get over the hump of transition, but it is not the only solution out there.

When breastfeeding creates trauma and frustration for baby, creating a positive atmosphere at the breast is crucial to preserve a long lasting and successful breastfeeding relationship.  If baby associates breastfeeding with struggle, pain, fatigue and/or anger you risk turning baby off to the whole experience. A nipple shield can be a protective measure here.

Getting several opinions and references from other moms too when dealing with a tongue tie is wise.  Talk to folks about it!

 

6. What should be considered before reaching for a nipple shield?

Everything else!  Really.  Have you assessed your own latch technique, baby’s mouth, palate, tongue, your nipple size?  Do you understand the mechanics of proper latch, what to look for, how wide a baby’s mouth should be, lips flanged nicely, tongue well extended and applied?  Do you understand normal newborn feeding cues? Have you tried different positions, laid back, side lying?  Different holds – football hold or cross-cradle for better control of your breast and baby’s head? Have you seen a lactation consultant or a La Leche League leader for help?

 

7. If a mom can’t find an IBCLC to help her in determining if she needs a shield, how to use it and when to stop, what can a mom do and where can she find help?

What about La Leche League or WIC Peer Counselors?  Maybe there are local support groups mom just isn’t aware of yet?  Ask around to midwives, at the health food store, local “meet up” groups and yoga studios. What have other moms in your neighborhood done when they’ve had breastfeeding trouble?

Does mom have a good breastfeeding book or two?  I recommend all expectant moms have a good breastfeeding book on hand before baby is even born.  And then write the name of a local IBCLC or LLL Leader and group meeting times right on the inside of the book so all your breastfeeding “go to” resources are in one place!  Mark the book up, put Post-its on pages that talk about issues you may be struggling with or curious about.  Titles I like are LLL’s Womanly Art of Breastfeeding, Dr. Jack Newman’s Ultimate Breastfeeding Book of Answers, and Nancy Mohrbacher’s Breastfeeding Made Simple.

The internet can be of help here as well.  First I’d head to other Leakies … see if they know of any lactation professionals in your area.  Mother-to-Mother support is the best!  Some new mother will have your back and provide you with the perfect gem of wisdom and support.

The internet is also a fantastic resource for videos and websites by all the great breastfeeding gurus out there.  And then there’s Skype.  Find an IBCLC who uses the internet a lot for her business and she no doubt will offer Skype services.  Obviously nothing compares to hands on face-to-face IBCLC support, but if that is impossible to find locally, Skype and email can be a handy 2nd best!  Just be sure to check the lactation consultant’s credentials, get references, and practice internet safety.

 

8. What are some reasons to try to wean from the shield as soon as possible?

This is a question about risk and why nipple shields can present a problem.  For one, they can be habit forming.  Babies are not dumb.  We all fall into comfortable habits and hold strong opinions about what we prefer and when and how we like change. Babies are no different.

When using a nipple shield it is best to remember it should be a short term solution and that you should continue to try to latch baby on without the shield often and frequently each day.  The best time to do so is typically after baby has suckled with the shield so baby is in a calm, and after you’ve had your first “let down” so milk is flowing.  The remove the shield and try to latch without it.

There is also the risk that a nipple shield may not be fitted or applied correctly and may yield poor latch technique, thereby limiting the stimulation necessary to create a strong milk supply.  Listening to baby swallowing, listening for a good “suck, suck, swallow” rhythm, watching for the swallow (milk transfer) can bring confidence baby is on well and milk is flowing.  And of course, continuing to count and watch diapers each day.

 

9. How does a mom know when to start weaning from the shield?

Again, each mother/baby pair is unique and what works for one may not be best for another.  This is where touching base with your lactation consultant will come in handy, and trusting that your baby will communicate with you when she’s ready.

I’ve worked with moms who struggled with a shield habit for months, lamenting its use – to only be shocked one day when baby suddenly at 5 months took the breast without the shield like they were a pro at it all along!

Babies are smart little cookies.  When they’re ready they will work with you to create the change (losing the nipple shield) you desire.  Be patient, as it can take some time.

 

10. How does she go about weaning off the shield?  

Part of weaning off a nipple shield goes hand and hand with what the risks are and why you are using it in the first place.  I think for the most part, when the time presents itself (when nipples have healed, when milk supply is abundant, when baby is calm and growing fat & happy, when mom has more confidence and a rhythm to her day) a mixture of  time, patience, persistence and compassion will bring about the transition.

I recommend that you try in a regular, methodical way.  Each time you bring baby to breast, if the timing is right, just after the milk starts to flow (after your initial let down) when baby knows milk is flowing, try removing the shield and see if baby will continue to latch without it.  Don’t give up!  It can take a few weeks for sure.

 

11. Anything else a mom needs to know about using nipple shields including potential risks/benefits or how to clean?

How to clean?  Nipple shields are dishwasher safe and like your breasts, don’t need to be sterile for baby to use.  Soap and water rinse in between uses are fine if you’re out and about and/or if a dishwasher is not available.  Also, shields come in varying sizes and brands so don’t be locked into a single brand/size. Know there are options out there.

I think a final statement about nipple shields should be what questions to ask yourself before you start using it.  Be your own best advocate …  ask yourself “why”? Why do I need this? Who gave me the nipple shield advice?  There are a lot of people out there who just want to dole out nipple shields like they’re candy!  Ask yourself, was it given to you on Day 1 at the hospital after a vague assessment by a busy staff person who may not even be a qualified lactation consultant?  Was the nipple shield recommended by a trusted sister who swore by it for her children but has different circumstances than you?  Were you wandering the aisles of a baby store and thought, “hey, maybe this will help my sore nipples”?  Did the recommendation come from an experience IBCLC who spent personal one on one time with you to assess what your breastfeeding circumstances, challenges and goals are?

Trusting that with care and proper instructions a nipple shield can be a useful tool, but also knowing when and how to avoid it will be a mother’s best wisdom when and if the subject of using one comes up.

Deirdre McLary is an IBCLC, RLC, CD, Birth, Breastfeeding & New Parent Expert. Deirdre is the founder of Breastfeeding Arts & Birth Services. Since 1997, she has served New York City and metro area families with all their birthing and breastfeeding needs. She is a certified labor support and postpartum doula, a childbirth educator, a La Leche League Leader and a board certified lactation consultant (IBCLC). When not helping individual families throughout the tri-state area, she can be found hosting a weekly Breastfeeding Cafe drop-in group locally in Nyack, NY, teaching childbirth and breastfeeding classes in Soho, NYC, and hosting & commentating on several live chats on Twitter and Facebook as a lactation and doula expert (#LCChat, #BirthGenius or #DoulaParty). Visit Deirdre’s website at www.breastfeedingarts.com or email her at [email protected]

 

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Nipple Shields: life-saver, supply -wrecker or just another tool for nursing mothers?

 by Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM

I confess, I didn’t know what a nipple shield was back in the day when I was still a very smart but breastfeeding “knowledge- challenged” pediatrician. I did know that whatever they were, they were bad. Very bad. “Never” use them under any circumstances. Ever.

Later, when my niece was born, in a hospital hundreds, nay thousands, or millions of miles away from me, imagine my horror as I found out that she needed a nipple shield to latch. This was bad. I didn’t know why. But it had to stop. So, as unsupportively as I could imagine (in retrospect) I told my sister to stop using that thing! I hadn’t met my niece yet, but I knew that she was less than 5 pounds soaking wet and that nipple thingy was going to ruin her chances of getting into the Ivy League.

One of my dearest friends in the world needed to use a shield when her second child was born. She asked for one when her third was born and was told “no” by the staff caring for her in the hospital. To me, it just was further proof that their use was fraught with problems.

I’m smarter now, at least I’m less breastfeeding-challenged, and I know better than to use the words “never” or “always” and to deny to a request without providing education and informed consent. And I’ve heard too many stories of success to discount the benefits of nipple shields for some mothers and babies. But the fact remains that we have no guidelines for nipple shield use. We have few studies rigorously done that show they are effective.

A nipple shield is a gadget that is placed over the nipple and areolar area. It looks sort of like a nipple (sort of), or a sombrero, but is made of plastic and there are different types. You can get them online and over the counter. The problem with them stems from studies (with flaws in the method in which they were done) that concluded that the use of the shield could decrease milk supply, were associated with more supplementation, and lead to early weaning.

That meant that if they were to be used, the dyad using them would need to be carefully followed, but many mothers were getting them and no follow up was scheduled. I’m not sure the logical result of that should be a compete ban on their use, but, well, they were highly discouraged. Of course, those studies were with older versions of the shield, and other research (with flaws in the method in which they were done) with newer versions of the shield suggested this wasn’t as a big a problem as we thought. But many of those same concerns exist. We honestly don’t know the short-term or long-term effects of nipple shield use.

Nipple shields are often given out in the nursery for “flat” nipples. My guess (no data, so definitely flawed study method) is that the nipples are puffy. And if that’s the case, this might be something to try.

They are often given out for a poor latch as a quick fix to a more complex problem, but we need to remember basics: skin to skin, baby-lead latch, biological nurturing. And asking for help from someone who is board certified in lactation, an “IBCLC.” The shield should not be a first step.

If it’s given to you because your nipples are sore, then in addition to the shield, we need somebody to fix the underlying problem and be your cheerleader and you heal and transition back to the breast. (Find a Lactation Consultant!)

So, suggestions:
If you are given a nipple shield ask why. Informed consent for any intervention means that you are given the required information, in an understandable manner that allows your voluntary participation and that helps in making a decision for a course of action. Questions you can ask to help fulfill informed consent: Why am I getting this thing? How long do I use it? How will it help? Might it hurt? What other things might I try? What type of follow up do I need?

If you are given a shield, and it works, well, cool. You need follow up by somebody who knows something about breastfeeding so we can work on the underlying issue that initially caused the need for the shield.

If you were given a shield and don’t like it, well, let’s get you some assistance and fix whatever the issue is that requires a gadget to fix it so we can go gadget-less.

Shields are meant to be temporary solutions. If you are still using it when your baby is months old, we really should be able to help you stop using it, if you want us to.

If you are given a shield, it works well, you baby is growing and you’re happy but everyone around you is like “ooooooh, those things are bad’ you have my permission to hear everything that that person says after that in the voice of Charlie Brown’s teacher (you remember that voice, or am I showing my age?)

Resources:
Baby led- breastfeeding:http://www.geddesproduction.com/breast-feeding-baby-led.php
Biological Nurturing: http://www.biologicalnurturing.com/
Skin-to-skin http://massbfc.org/providers/SkinToSkin.pdf
Find a lactation consultant: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

Health professionals’ attitudes and use of nipple shields for breastfeeding women. http://www.ncbi.nlm.nih.gov/pubmed/20524842
Nipple shields: a review of the literature. http://www.ncbi.nlm.nih.gov/pubmed/20807104

 

 

 

Dr. Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM is a general pediatrician and International Board Certified Lactation Consultant in southeastern Wisconsin. Find her sound, evidence-based and helpful advice on parenting at www.drjen4kids.com and Lakeshore Medical Breastfeeding Medicine Clinic.

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