For the month of November, the Thursday Truth series will focus on various breastfeeding devices in order to better assist you in choosing the appropriate tool and using it correctly. This week, let's discuss nipple shields.
Nipple shields, devices worn over the breast DURING a feeding, have been found in recorded history in one form or another for at least 500 years. Originally made of pewter, bone, wood, lead, glass, and even animal skins, they have changed through the decades.
The 1950's to mid 1970's found the shield designed out of thick rubber, which research showed decreased the effectiveness of milk transfer by the baby. Only 20 years ago, I was able to buy a nipple shield of glass and rubber in a little pharmacia in Nuevo Laredo, Mexico for less than $2.00---certainly not a good device to use for milk transfer or nipple protection!
The new silicone nipple shields currently on the market seem to have the least negative effect on milk supply and milk transfer, if sized and applied correctly. Keep in mind the basic principles for milk transfer: the breast should be compressed, negative pressure provided to assist the breast in pushing milk out and into the baby, and the latch should be deep enough to prevent nipple compression at the anterior oral space, which can lead to nipple damage and pain.
When applying the shield, size really does matter. Lactation consultants used to size the shield according to the infant's mouth. However, we now suggest sizing the shield according to the maternal nipple, as we want as much of the nipple tissue inside the shield as possible to meet the principles of milk transfer. With that in mind, there are several ways to apply the shield to the breast. This video is pretty close to the method I have developed over the years:
This technique is not included in the instruction handout for any of the brands of shields on the market (at least not that I've been able to find). So without correct teaching regarding the how-to's and the why's of effective application, mothers may report nipple pain and damage, reduced milk supply, and slowed weight gain or even weight loss by their baby.
Here is a link to a free downloadable research overview on nipple shields: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014757/pdf/bfm.2010.0003.pdf
When should you use a nipple shield? Research has demonstrated an advantage for premature infants and some late-preterm infants, as the shield keeps the nipple well-placed in their mouths and they expend less energy having to regather and maintain the latch each time they relax the negative pressure in the oral space. Mothers with truly inverted nipples or those with flat nipples but non-compressible breast tissue, making the formation of a 'nipple sandwich' impossible, might benefit from a shield also. Although they are advertised by many manufacturers as a "quick fix" for sore or damaged nipples, without determining why the pain or damage was created in the first place, they usually will not resolve the problem and in some cases, they will actually make it worse.
Shields should be used under the direction of an International Board Certified Lactation Consultant. If a shield is given to mothers during the brief hospital stay, post-discharge follow-up by an IBCLC is a must. Frequent infant weight checks should be done, assessment of the maternal milk supply provided, and nipple pain evaluated. NEVER should a nipple shield be dispensed to a newly postpartum mother without a full discussion and demonstration of correct application and follow-up. And never, never, never use a bottle nipple over the breast in place of a nipple shield.
Sources for nipple shields are many, and there are a few features you might want to evaluate prior to using a particular brand. First, how many sizes are available? We all know that all mothers are not built the same, and even the same mother may have two very different breasts and nipples. Second, what is the shield made from? Latex is not recommended due to the allergen potential. Third, put your hands on the shield: try stretching it, turn it inside out and feel for roughness at the very tip of the interior side. Remember the maternal nipple should be as deep into that shield tunnel as possible; if there are raised areas (and there are several brands with those!), mother's nipple tip has the potential to come into contact with that area, leading to abrasion, bleeding, and potentially premature weaning.
What have you found to be some of the benefits and detriments to using nipple shields in your facility? How do you provide follow-up following discharge? Share to everyone to benefit from!!
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