Guest Author - Nicki Heskin
Nipple shields are a thin, silicone artificial nipple, with holes in the tip (think of a tiny, clear Mexican sombrero). They are most commonly used to help the baby latch onto inverted or flat nipples, or sometimes to assist any baby who is having a hard-to-correct difficulty latching. It is also sometimes used to regulate the flow of overabundant milk, sometimes known as overactive letdown, early in nursing. (Overabundant and fast-flowing milk supply can sometimes cause the baby to choke, throw up, and/or reject the breast.) It is also used occasionally for severely sore, cracked or painful nipples.
Nipple shields are a somewhat controversial tool in breastfeeding support. Breastfeeding "purists" believe that any sort of artificial nipple endangers and interferes with establishing a normal course of breastfeeding. For a long time, Le Leche League would not recommend them, although their recommendations now seem to be more mixed. Personally, I know many women that simply could not have been successful at breastfeeding without the early assistance of nipple shields, including myself!
When my first daughter was born in 2002, nipple shields were only available through a lactation consultant or other breastfeeding professional. Now Medela and other companies offer nipple shields on the shelf at Target and Babies R Us and other common retailers, and even online at Amazon. While it is nice in some ways that they are more accessible, there are some risks associated with their use, and it is best to use them only when truly necessary, and in my opinion, in consultation with an experienced breastfeeding professional or trained peer counselor.
The biggest concern with nipple shields is that they can decrease milk supply. This doesn't happen with all women, but it definitely can with some. Nipple stimulation along with milk removal are the most important factors that influence how much milk the body produces. While nipple shields allow for milk removal, the nipple stimulation is reduced, which can cause milk supply to not increase with the baby's needs, or in some cases, even reduce. When this happens, pumping after feedings to completely empty the breasts and stimulate additional supply may be necessary for as long as the shields are in use. This is why it is best to be under the supervision of a professional when using the shield, who can be checking in with the baby's ongoing growth and elimination as well as "breast behavior" to evaluate whether this is occurring.
In my opinion, sore nipples are not generally enough of a reason to use a shield. I'm not trying to minimize the difficulties and pain sore nipples can create – but the risk of milk supply reduction makes me want to handle nipple soreness in other ways, leaving the shield as only a last resort in very specific cases. In the case of nipple pain that severe, seeking professional or qualified lay help would be appropriate anyway, there are likely root problems that need correcting rather than just "treating the symptom" with a shield. My main concern about shields over-the-counter availability is those who would see them as a simple soreness aid. Actually I just took a look on Amazon at the Medela, Ameda and Avent brands. As of the writing of this article, Medela and Ameda were both very responsible in their descriptions – Ameda even stated outright the product should be used under the guidance of a professional. Avent however, calls their product a "nipple protector" and describes it as a soreness aid. In my mind, this is hugely irresponsible.
Nipple shields can be used for the duration of breastfeeding or can be weaned when the baby is ready. I don't believe that permanent use is preferred, mainly because of the inconvenience of carrying and cleaning the shields is both troublesome and may lead to decreased duration of breastfeeding. But I also don't believe that women should be stressing themselves out trying to wean before the baby is ready. For more information, see my article "Weaning from Breast Shields." In general though, it is important to know that using a shield is not a "life sentence" – for most weaning is certainly possible when the time is right.
Nipple shields, when used properly, can be an important aid for those with flat or inverted nipples, or for babies with difficult latch problems. Under appropriate supervision, they may also be appropriate for those with other difficulties, including overabundant milk supply or milk flow, or extreme nipple pain. Despite some controversy, I see them overall as a positive force helping women to breastfeed who may not otherwise achieve success.
View and Compare Nipple Shields on Amazon.com
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