Breastfeeding can be fraught with difficulties, this is where nipple shields step in.
Dr Deborah Lee of Dr Fox Online Pharmacy explains the function of nipple shields, lays out when you should consider using one, and how to do so safely and effectively:
What is a nipple shield?
Nipple shields are useful for women who are having issues getting their babies to latch on. ‘The baby may find it hard to latch on if there are flat or inverted nipples, as the nipple is just not prominent enough for them to grasp by their mouths,’ says Dr Lee.
‘Sometimes, babies may have a physical impairment which interferes with attachment to the breast, for example, a tongue-tie, which means they cannot open their mouths wide enough. Babies may also develop sore mouths, for example, from oral candidiasis.’
Alternatively, they may be useful for a mother who is experiencing cracked or sore nipples from breastfeeding. ‘Because the nipple is covered over, it is shielded from possible trauma as the baby latches on and starts to suck,’ she adds.
Contrary to what you might’ve heard, nipple shields should only be used when recommended by a midwife. ‘Using nipple shields can have negative consequences on breastfeeding, so they are only recommended in specific situations,’ Dr Lee says.
Even though nipple shields may help facilitate nursing – especially in those tricky first few weeks – they aren’t a cure-all. In the first few days of life, it’s very important to establish a good feeding technique for mother and baby, explains Dr Lee.
‘Skin-to-skin contact with the baby’s face lying close to the mother’s breast is important for maternal bonding and the baby’s emotional and social development,’ she says. ‘Nipple shields act as a barrier between the baby's cheek and maternal skin, and so may interfere with these natural processes.’
Furthermore, if the nipple shield is the wrong shape or size, it may actually reduce the baby’s ability to suck and swallow at the breast, rather than encourage it. ‘This can then lead to less milk production and a frustrated hungry baby,’ Dr Lee continues. ‘If the milk let-down reflex is disturbed, the mothers’ breasts may become engorged with milk, causing breast pain. She may quickly become disenchanted with breastfeeding and abandon it.’
A survey of almost 5,000 mothers published in the journal Maternal and Child Nutrition found that first time mothers who tried a nipple shield were three times more likely to give up breastfeeding. ‘Some mothers did find the use of the nipple shield helpful, although they commented they tended to become dependent on the use of the shield,’ says Dr Lee.
Why you might use a nipple shield
With all that said, a nipple shield may be a useful tool for mothers who are having issues getting their babies to latch – an experience that is all too common.
‘New mums know only too well that learning to breastfeed takes time and patience in those precious early days after delivery,’ says Dr Lee. ‘Mums are tired, often after a long, painful labour and delivery and are not used to the 24-hour demands of a tiny baby.
‘The baby must learn to latch on to the breast, suck, swallow, all the while coordinating breathing,’ she continues, ‘and for many mums and babies, this takes days or even weeks and requires the support of an experienced midwife.’
In some specific situations, the use of a nipple shield for a short period of time may provide some relief and support in the early days. The midwife will suggest a nipple shield if they think it appropriate, says Dr Lee. Such instances include:
1. Flat nipples
Flat nipples – sometimes called inverted nipples – fail to become erect when the areola is pinched. ‘Flat nipples are common and can be unilateral,’ says Dr Lee. ‘This can be a problem if the baby cannot find the nipple correctly in order to latch on.’ If flat nipples are identified in pregnancy, some midwives recommend wearing breast shells. ‘These are fitted over each breast and put pressure around the areola to draw the nipple out,’ says Dr Lee continues. ‘After delivery, if nipples are inverted, use of a certain type of breast pump may help to draw out the nipple. Alternatively, sometimes a nipple shield is recommended.’
The ability to suck and swallow develops at around 34-36 weeks of pregnancy. ‘Premature babies are therefore initially fed in special care using a nasogastric tube,’ says Dr Lee. ‘They then may have difficulties in learning to suck and swallow from the bottle or the breast.’ Sometimes a nipple shield is recommended for a premature baby, to try and help them latch on and to stimulate milk production, ‘however, use in neonatal units remains controversial’.
3. Bottle to breastfeeding
In the early days after giving birth, women sometimes need to express breast milk with a breast pump and feed the baby via a bottle. ‘When their breast milk production becomes established, and the baby can suck and swallow well, it is possible to transfer the baby back to the breast,’ says Dr Lee. ‘However, as the baby has got used to the artificial teat of the bottle, using a nipple shield may help encourage the baby to latch on at the breast. In due course, the nipple shield is then discontinued.’
4. Sore nipples
Sore nipples are common among new mothers. Most commonly this happens because the baby fails to latch on correctly, says Dr Lee. ‘The baby must be correctly positioned at the breast, with the whole nipple area – this means the nipple plus the areola – in their mouth,’ she explains. ‘New mums and babies often need the help from the midwife to get this right.’
Nipples may also become sore as they are constantly becoming wet and dry, due to frequent feeds and sometimes leaking milk. ‘It’s important to keep nipples clean, and dry,’ says Dr Lee. ‘Using breast pads helps absorb any leakage. Some studies suggest the use of aloe vera gel or lanolin creams can be helpful.’
In severe cases, the nipple can become ‘swollen, inflamed, and may develop cracks called fissures, which are very painful,’ she continues. ‘There is a risk of developing mastitis, or a breast abscess, both of which are serious and very unpleasant. If nipples are becoming sore and cracked, use of a nipple shield may sometimes be advised.’
A little strip of skin attaches the tongue to the floor of the mouth, and if this little piece of skin is too short, it’s called a tongue-tie. ‘When a baby has a tongue-tie, they may not be able to open their mouth wide enough to get the whole areola into their mouth,’ says Dr Lee. ‘They may also not be able to compress the nipple correctly in their mouth. Feeding is hard work and does not give them enough milk, and they can become miserable and exhausted.’ Most babies with tongue-tie have a simple operation to fix it. ‘However, there can be a wait to get this done, and an instant solution is needed,’ she says. ‘Some babies will find using a nipple shield can be helpful.’
How to use a nipple shield
For a baby to breastfeed properly, they must be correctly positioned at the breast, and have correct attachment, with the whole nipple in their mouth, including the areola, says Dr Lee. If breastfeeding is correct, the baby will have their mouth wide open, with the lower lip curled outwards and their face resting against the breast.
‘As the baby sucks on the nipple, they push the nipple against the hard palate, squeezing milk out of the ducts, and swallowing,’ she explains. ‘The movement stretches the nipple and sends signals to the mother’s brain, stimulating the production of the hormone oxytocin, which is vital for milk production and milk let-down.’
Before you decide to buy a nipple shield, The Association of Breastfeeding Mothers (ABM) recommends trying the following:
- Get expert breastfeeding support – both face-to-face and hands on
- Try rubbing a little milk on the nipple to encourage the baby to latch on
- Use a breast pump every 2-3 hours to stimulate milk production
- Try holding your baby to feed in different breastfeeding positions
- Try using ice on the nipples to encourage them to become erect
- Relieve the breasts if they are engorged with milk
Breastfeeding is pleasurable for mother and baby and should not be painful for the mother, says Dr Lee. If your midwife has given you the go-ahead to use nipple shields, follow the manufacturers instructions, which should read like this:
- Always sterilise the nipple shield before first use. Moisten the areola with a little water.
- Holding the nipple shield facing towards you, with your thumbs either side of the teat, bend the rim of the shield as if you were going to turn it inside out, but stop halfway.
- Place the nipple shield over the nipple, being careful to place it centrally, and covering the hole at the tip of the teat with a finger.
- Roll the rim of the nipple shield down over the breast and press firmly onto the breast. Keep the holes in the teat covered while you do this, as it creates suction and will draw the nipple up into the teat.
- When the baby is correctly positioned, latched on and sucking, you will be able to see the breast moving as the milk is being ejected.
- When you use a nipple shield to breastfeed, each time the baby sucks, this draws the nipple more firmly into the shield and helps ensure the nipple is correctly stretched.
When you’re finished with feeding, wash the nipple shield with warm, soapy water and dry it with a towel. Store it in a clean container.
Which size nipple shield should I choose?
Nipple shields come in different sizes, designed for small, medium, or large diameter nipples, so you need to know your measurements, says Dr Lee. Measure across the width of the nipple, 0.5 -1 cm from the tip, where the nipple meets the areola.
- Small: 16mm
- Medium: 20mm
- Large: 24mm
- Extra-large: 28mm
Instead of using nipple shields, you may prefer to try a contact shield, which has a cutaway portion to allow the baby’s cheek to rest against the breast.
How to wean a baby off a nipple shield
If the baby is feeding well and gaining weight, there is no rush to stop using the shield, says Dr Lee. ‘When you do try to wean your baby off the shield, it may be easier mid-feed, when your baby is less hungry, a bit sleepy and receptive to change,’ she says. ‘If it doesn't work, stay calm, replace the shield, and try again next time.’
Last updated: 24-08-2020
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