Nipple Shields

Nipple Shields (aren’t cheating)

When it comes to tools in the breastfeeding tool box, nipple shields are my favorite.  There are a  lot of people out there that would criticize me for that, siting that nipple shields are “cheating” or lower milk supply.

1. Nipple shields aren’t cheating

2. Nipple shields don’t lower milk supply when used properly

Disclaimer: I only work with Medela contact nipple shields. There are a number of nipple shields on the market, some of which are crap, like the Tomee Tippee nipple shield and some of which as passable, but I don’t like or use any brand except Medela.

Also, if you use a nipple shield, you should at least see a lactation consultant once to make sure you are using it properly and that the baby is transferring the milk through the shield properly. The comfortable and effective rule still applies here.

1. Nipple shields aren’t cheating.

If I were to give you the choice of

a. pumping & bottle feeding

b. not breastfeeding at all

c. breastfeeding directly with a nipple shield

Which would you choose? Yeah, I would pick the shield too.  Nipple shields are a tool, a stepping stone to get you to full breastfeeding.  Eventually, when you start to trust breastfeeding with the shield, you can work with a consultant or alone at home to wean off the shield.  But, contrary to popular belief, there is no time at which a baby must be weaned from the shield.  I have helped babies wean from the shield as late as 4 months.

The funniest thing to me though is how fickle women are about their nipple shields.  When they first start working, women love them and can’t imagine ever wanting to not use it. Within a week or two, they have learned that nipple shield disappear in the middle of the night (because they are clear!) and they are pretty stinking annoying.  I get it, one you get a taste of what it feels like to really breastfeed your baby, you are eager to get rid of any and all extra equipment, but…let’s first give some love to that nipple shield!

2. Nipple shields don’t lower milk supply when used properly

Below is a video if progress that I am developing for a future online program. I haven’t voiced over it yet, but it is a really nice example of how a nipple shield should fit and how to latch a baby onto it.

A few things you should always pay attention to when you use a nipple shield:

You pick a nipple shield size based upon your nipple size, not the size of the baby’s mouth.  The largest Medela nipple shields is only a 24 mm, which is the same diameter as a standard pumping flange.  That means that if you have large nipples, you may not be able to use a nipple shield at all.  Note in the video how there is a little space all around the nipple shield before and after the baby nurses. Meaning, the nipple isn’t squashed inside the shield. If you are trying to shove a big nipple into a little shield, then the baby won’t be able to transfer milk properly (and it will hurt!)

The cut out of the shield should be placed where the baby’s nose will land. Notice how in this video the shield flips back onto the baby’s face, but her nose isn’t blocked.  Shields tend to do this, so you will feel better knowing that the plastic won’t block the baby’s nose.

Your nipple needs to be centered in the shield. This video doesn’t show it, but try curling the shield back like a little sombrero, then placing it on top of your nipple. This creates a little vacuum and keep the shield in place.

Baby’s lips should be flayed out and touching the breast. The shield should not be popping in and out of the baby’s mouth.  The sensation should be a strong tug, not a painful pinch.  If you can’t feel a strong tug, the shield may be a little too big or the baby may not be giving a strong enough suck.

And in my opinion, unless there is proof (ie a pre/post weigh by a lactation consultant), there is no need to pump after every nursing session when using a shield. That is just cruel and unusual punishment.

Lastly, here are some times when nipple shields are appropriate:

Nipple confusion- my favorite.  If we have a baby that was exposed to another nipple and can’t seem to figure out how to get on the boob (think angry trout on a fishing line). This baby shakes his head, rooting uncontrollably with the nipple in his mouth, but he just won’t suck!  This baby is waiting for something to his his sucking reflex in the roof of his mouth and the breast just can’t do that.  Here, a nipple shield will elicit his sucking reflex and get him right on. This will teach him to trust that milk comes from the breast again and give mom the confidence that she can feed the baby again.  Once the two of them have nursing with the shields down pat, she can consider weaning off the shield when she is ready.

Flat or inverted nipples- I mean, I know babies breastfeed, not nipple feed, but how is a baby supposed to latch onto a bowling ball? Even if the baby can get on a little in the first few days, once mom’s milk comes in that nipple is going to get even flatter and her breast tissue firmer making latching virtually impossible. Slap a shield on that booby.

For a premie that needs extra oral support when learning how to nurse.

SOMETIMES for nipple pain. Shields are not meant to fix nipple pain. If you try to use a shield on top of busted up nipples, it may help a little at first, but it isn’t going to fix the problem. So, if you are using a shield because you have sore nipples, it is time to see an IBCLC.