When baby isn’t latching or breastfeeding trouble hits, well-intentioned health professionals sometimes dole out the nipple shields. A nipple shield is a piece of flexible, nipple-shaped silicone that mom wears over her nipple while breastfeeding. Nipple shields allow the baby to grasp mom’s nipple with ease, but unfortunately, they can also lead to bigger breastfeeding issues down the line.
For starters, nipple shields can interfere with milk production and therefore baby’s milk intake. To breastfeed her baby, mom is dependent upon two hormones: prolactin and oxytocin. Simply put, prolactin prompts milk production and oxytocin triggers milk ejection. Prolactin is dependent upon frequent nipple stimulation and oxytocin gains muster by nipple stretching: breast massage, breastfeeding, pumping, and hand expression. It is, therefore, easy to see how placing a piece of silicone between baby and breast could interfere with both milk production and milk ejection. With the ongoing use of a nipple shield, mom can develop milk supply issues and baby can suffer the effects of insufficient milk transfer, namely poor weight gain. The restricted milk flow not only interferes with milk supply, but can also lead to breast issues for mom, such as plugged ducts or mastitis.
But it takes two to tango: mom’s breast and baby’s mouth. For a baby to successfully breastfeed, he must also perfect the latch. Baby must tilt his head back, open wide, and latch deeply onto the breast, grasping beyond the nipple and taking more of the lower part of the breast into his mouth. A nipple shield simply requires baby to attach to the nipple, without engaging the rest of the breast properly. Inside the mouth, the dance continues. Baby must drop his tongue and stretch the nipple up towards the roof of his mouth. To stop the flow of milk, he merely stops elongating and stretching the nipple upwards. When a baby nurses with a nipple shield, however, he learns to push his tongue to the roof of his mouth to slow the flow of milk. This means that with continued use, the nipple shield creates problematic learned behaviors that are not conducive to breastfeeding without the shield.
However, nipple shields DO have their purpose. They can be a useful tool for teaching a premature baby to breastfeed or bringing a baby who refuses to nurse back to the breast. Too often, however, nipple shields are prescribed for baby before all other options are exhausted. Unfortunately, this usually happens early on in the hospital or clinic setting where the professional does not have the time to work with mom and baby on proper latching techniques. So while nipple shields can be very useful in certain situations, more often than not they are more trouble than they’re worth and should only be used in limited situations and only under careful supervision.
While it is always better for a baby to breastfeed with a nipple shield than not at all, the long-term goal should always be to wean baby from the nipple shield. As more time passes, it becomes harder and harder to do this, but it is never impossible. With a little patience and a lot of hard work, it can be done. While some babies can make the switch within a few days, others take several weeks to make the transition. Here are the first few steps to getting your baby back to the bare breast.
- Protect your milk supply. Until baby can successfully latch onto the breast, ensure that you receive enough nipple stimulation and empty your breasts often. Following every feeding, pump until your breasts no longer express additional milk.
- Practice good latch behaviors. Even with the nipple shield, make baby perform good latching technique: position baby’s nose to your nipple, wait for baby to gape widely, and bring baby to your breast, scooping the breast into baby’s mouth beginning with the bottom lip and allowing the top lip to close the seal.
- Practice skin-to-skin. Studies show that the more time baby spends skin-to-skin with mom, the more interested baby becomes in breastfeeding, making the weaning process that much easier.
- Breastfeed frequently. Do not allow baby to get too hungry. Offer baby the breast before he cries so that he has the patience to practice nursing without the nipple shield. Or try offering the breast while baby is still drowsy, ideally while skin-to-skin. Some babies are more amenable to breastfeeding in the drowsy state.
- Prep your breasts. Reward baby for his behavior by stimulating let-down before baby comes to the breast. Pump or hand express to get things going and allow a few drops of milk to remain on the nipple.
- Make a nipple sandwich. Compress your breast and hold it firmly about 1 1/2 inches from the base of your nipple toward the chest wall (usually at the edge of the areola just past where your baby’s lips will be). Holding the breast this way makes your nipple firmer, like the shield. Keep holding it like that until it feels like baby is sucking well, and then slowly release the grip.
- Use distraction techniques. When baby shows signs of frustration, “shhh, shhh, shhh” him, create a gentle and slight rocking or bouncing motion, and rhythmically pat the buttocks.
- Keep baby calm. If the distraction techniques do not work, stop. Remove baby from the breast and calm him down. DO NOT allow him to become frustrated at the breast. It will only make him more resistant to breastfeeding.
- Start with the nipple shield. If baby wants nothing to do with the bare breast, begin nursing with the nipple shield. Once baby is nursing well and let-down has occurred, remove the shield and latch baby to the bare breast. With each feeding, begin to remove the shield earlier and earlier until you don’t need it at all.
And of course, Ybreast is always here to help, serving you and all of your breastfeeding needs, without judgment.