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 BreastfeedingArts@gmail.com