The Ins & Outs of the Nipple Shield
A Nipple Shield as is commonly seen today is a thin, often silicone barrier place over the nipple and areola. We often ask, why does breastfeeding seem so hard now? Forms of nipple shields have been around for a very long time. They had previously been made out of various materials – rubber, glass, lead etc. Currently shields are used for a variety of situations. It is often used in instances when baby cannot latch onto the bare breast. It can also be used in instances of a super-fast flow and when some infants are accustomed to the feel of silicone vs skin. It is often used in instances where continuing of breastfeeding seems unimaginable to the family and it is the shield or switching feeding methods. The use of a shield though is something that is recommended to be used under the instruction and guidance of an IBCLC (International Board Certified Lactation Consultant). They will be able to determine if a shield is appropriate and if you are using it as recommended. The objective is to not just have baby latching onto the shaft of the shield. Although a shield may reduce nipple pain while latching, without proper use, it doesn’t encourage appropriate breast stimulation. Our goal is still to have baby taking both the nipple and areola tissue into their mouth to effectively suck, swallow and stimulate the breast.
There are many strategies on how to put on a nipple shield, this is just one I have seen be used.
Step 1: have you nursing station set up with the things you would normally need, be comfortable and have baby nearby.
Step 2: turn your nipple shield upside down and push the shaft into itself like a sombrero
Step 3: turn the shield right side up and place the shortened shaft evenly over your nipple. Press into the breast.
Step 4: encourage the shaft to pop back into its full length, drawing the nipple into the shaft.
Step 4 on the knitted breast. This shield is fitting a little large and can’t be drawn into the shaft.
Note that this shield is fitting a little squishy for this person. However, it should be noted that this is a size 28 shield and this person has particularly thick nipples. Ideally there would be more space between the nipple shaft and the shield shaft.
Step 5: Optionally, you can add a little nipple balm, breastmilk or water to keep the edges attached to your body. However, ideally, the suction of the nipple up into the shaft vs just setting the shield onto the breast should keep things into place.
You will know that your nipple shield is fitting well when your nipple fits into the shaft with minimal rubbing on the sides, without excess space on the sides and with as little extra length to the shaft. This last point is variable with infant oral anatomy as well as maternal anatomy. These are intricacies that an IBCLC should be watching for.
We may find when latching baby with a shield on that breast shaping becomes more challenging. We still focus on bringing baby onto the breast quickly and firmly with a wide-open mouth but breast shaping may not be as helpful. What we want to make sure we aren’t seeing is baby sucking only on the shaft of the shield. Furthermore, we don’t want to only see the shaft of the shield moving in and out of baby’s mouth. This will not provide appropriate simulation to the breast and milk transfer will almost certainly be less efficient. We should see baby with areola tissue in their mouth, as if they were on the bare breast.
A significant pro to their use is preserving the breastfeeding relationship under circumstances that would otherwise make continuing unlikely. Can be used long term if necessary.
Some cons can be having to have another tool clean and ready to use. It is another thing to manage. With improper use it can impact overall milk production. It may not actually fix why latching has been challenging but can be used as a band-aid while other elements are addressed. They are often handed out or recommended without proper follow-up and can be misused.
Nipple Shields can be cleaned with warm soapy water, rinsed and air dried. Sterilization is not necessary and may damage the shields themselves. It is recommended to have a few on hand. In your bag for being out of the home, in different spots around the home so that you don’t have to go searching.
Rachel O’Brien has a fantastic article for when or if weaning off a shield is the right decision for you! Read it here.
As always, it is important to have a conversation with a lactation professional to help decide if a tool like a nipple shield is right for you. There are many intricacies when it comes to suck and swallow coordination and helping tease apart the circumstances is what those professionals are there to help with!
Natalie IBCLC - March 1, 2022