S.H.I.E.L.D

Use of nipple shields is controversial in the world of breastfeeding and for good reason – you shouldn’t need them. Nipple shields should be a short term solution – if your baby can’t latch or breastfeeding is painful then nipple shields help in that they allow the baby to latch and allow the nipples to heal, but they can’t resolve the problem and that problem really does need to be identified and resolved. And I think that is the crux of the problem not so much with nipple shields themselves – in reality they are an amazing device which would otherwise have prevented me from breastfeeding – but because they are recommended without due care and attention.
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I was told to use them because my nipples were flat, I used them and it was only six weeks later when I thought I should wean Elphie off them that it was discovered that my nipples in fact were not flat, Elphie was tongue tied. But by then it was too late – Elphie was hooked on them and although physically she could nurse normally after the revision, she didn’t want to – she was used to the silicon nipple and didn’t want this weird fleshy nipple that required a slightly different technique (wider mouth, less just sucking it in).

I battled to get her to breastfeed normally – tears were shed (both hers and mine), breastfeeding drop-ins were attended, we reverted to skin to skin, and although sometimes she would latch on most of the time she wouldn’t and she would cry until I gave up and went for the shield.

I started questioning myself – why was I so desperate to wean her off the shields? She was feeding well on them, my milk supply seemed fine and she seemed to hate breastfeeding without them. The advantages of normal breastfeeding over doing so with the shields would be less sterilising and less risk of meltdowns if I forgot the shields and less of a dent in my pride due to an inability to breastfeed. But were these really reasons to upset her? Wasn’t I just being selfish trying to get her off them? I was trying to be responsive to my baby and led by her and yet here I was doing precisely the opposite, trying to get her to do something she obviously didn’t want to do.

So I decided to let it go a bit – I wouldn’t try and force it any more, and instead just try to offer the breast without a shield from time to time and see if it worked, and if it didn’t them it would be straight back to the shield. It just wasn’t worth upsetting her for.

So I had resigned myself to a breastfeeding life of shields and even bought a new pair so I could leave it in the changing bag and know that I had a pair on me.

Then I read an article on Dr Jack Newman’s site about nipple shields and it scared me – basically it was suggesting that even if now my milk supply was good, by using the shields it could dwindle over time. Now I have a lot of respect for Dr Jack so I took this seriously even though I had no indication that there was any issue with my supply and KellyMom is less dire about nipple shields in general.

But because of this I decided to push normal breastfeeding just that little bit more. Now every feed I would start by trying the breast, and if it didn’t work out so be it, I wouldn’t force it but I would still try. I would also persevere if she delatched but not if she delatched and was upset – you see I realised that when she started to feed it took a while for her to get going and that she would often delatch even with the shields, I was just being too hard on myself and assuming this was a problem when actually it was business as usual.

Surprisingly this gradual breastfeeding introduction seemed to work – more and more she is taking to it. At first she was doing at most half feeds before wanting the shields, but this built up to whole feeds on one side and then on both. Till you have days like today where she’s only used the shields for half of two feeds – and I offered on others, she just wasn’t interested.

I think whatever is going on with her apparent pre-teething may have helped. The normal breast seemed to be more soothing for her poor gums than the shield, so she was happy to swap.

Moving across I drew a lot from the recommendations I had previously been given from the drop-ins and my local La Leche League meeting. Some of the techniques suggested were specific to weaning from a shield, such as removing the shield half way, but most of them were pure breastfeeding tricks that would apply to anyone trying to perfect a latch-on. The two that helped the most for me were:

  • The big breast sandwich – squeezing your breast to make a big chunk of skin for the baby to latch onto. Your thumb can be as close to the nipple as you want, you are looking for a big fleshy chunk below the nipple to be part of the sandwich as that’s where the milk reserves are that the baby needs to lap at
  • Flip it in – putting the nipple above the baby’s upper lip and flipping it in at the last minute when they try to latch on.
  • And there’s nothing like sock puppets to explain how both of these work:

    Kellymom has a whole range of other techniques for shield weaning and breastfeeding in general – and it really is worth trying them all because you can’t predict what will or won’t work. For instance, laid-back breastfeeding is the number one successful breastfeeding position, yet put me and Elphie in this position and she’s diving off the sides and I look like my neck is getting a crick – we just don’t get it.

    One of the key points the site makes is that a good latch is defined by it being comfortable and effective – if you are in pain or your baby is not gaining weight then there is something wrong that needs sorting!

    As for nipple shields, the jury is still out. A 2010 review of the literature on nipple shield use found that the amount of milk transferred was less with a shield than without, however, if the baby was premature and struggling to latch then in that scenario nipple shields provided more milk. Their conclusions were:

    “Introducing NSs in the first postpartum week may seem like an easy fix for a frustrated family, but such intervention may preclude a thorough evaluation of the mother–infant dyad to determine why breastfeeding has been problematic and may cause more problems such as lack of effective milk transfer, sore nipples, and loss of milk supply. The pervasive use of NSs as an intervention in the very early course of breastfeeding can relay a false message of breastfeeding success and safety to mothers. Widespread retail access to NSs might also signal to mothers that NS use is a norm that warrants little concern. Mothers who use an NS should be followed by a knowledgeable health professional to help them transition away from NS use, monitor infant growth, and screen for milk supply changes or other breastfeeding problems.”

    Nipple shields have a place in this world and I am grateful to them, I just wish the midwives and breastfeeding specialist had spotted the problem so I wouldn’t have needed them in the first place.

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