Nipple shield politics

Why was I told to never use a nipple shield?

Health-care providers may disagree about the use of nipple shields. Our clinic has found them effective for some babies and supports their use by mothers who find them helpful. Some mothers use a nipple shield for the entire breastfeeding period and feel a sense of accomplishment in having overcome latching problems. Some health-care providers believe nipple shields reduce milk transfer and prevent emptying of the breast. They recommend expressing after every feed. This is unnecessary if the baby is full-term and getting enough milk. Some people worry that babies may become used to the nipple shield and won’t be able to breastfeed without one and this is a valid concern if using a nipple shield for nipple pain. However, if the baby has a latching problem, a nipple shield may allow breastfeeding that would otherwise be impossible.

A) When to use a nipple shield

Like every other tool, nipple shields need to be assessed and used only when appropriate. Do not use a nipple shield if it is not effective.

We have found nipple shields to be effective for 60-70% of babies who try it. You should consider using one if you:

  • Find it helpful for you or your baby.
  • Have decided after exploring all your options that using a nipple shield is the best choice for you and your baby.
  • Know how to use it.
  • Have help from qualified health-care providers (Ekström 2014).

In our experience, mothers are generally keen to stop using the nipple shield because it adds steps to each feed. However, a nipple shield allows some mothers to breastfeed when they would otherwise be unable to. Their only options are then expressing and breast milk-feeding or infant formula-feeding.

 Mothers may feel a sense of accomplishment in having overcome latching challenges, even if they needed a nipple shield to do so (Brigham 1996). We have worked with many mothers who have used a nipple shield for the entire breastfeeding period and well past one year of age.

B) Different opinions

In recent years, the use of nipple shields has become more widely accepted but some providers still have reservations about their use (Eglash 2010). 

1) Expressing after breastfeeding with a nipple shield

Some health-care providers believe that all nipple shields reduce milk transfer to the baby and prevent effective breast emptying. They advise mothers who use nipple shields to express after every feed to ensure the breast is emptied in order to prevent a decrease in their milk supply.

This is good advice if the baby is premature and still developing breastfeeding skills and is not yet breastfeeding effectively. However, this is not the case for a full-term baby.

If a full-term baby is getting enough milk while breastfeeding with a nipple shield, there is no need to pump after feeds. If the baby is not getting enough milk, there is a limited benefit to using one and we recommend that the mother focuses on expressing and supplementing the baby with breast milk. Breastfeeding with a nipple shield can be used to calm the baby.

2) Getting dependent on the nipple shield

Health-care providers may say the baby will become used to the nipple shield and will not be able to breastfeed without one. This is a consideration when using the nipple shield for nipple pain and when the baby can latch onto the breast without one. For this reason, we generally recommend other approaches before considering using a nipple shield for pain.

However, if the baby has a latching problem and cannot breastfeed without a nipple shield, the nipple shield can be very effective at preserving breastfeeding. These babies are not “used” to the nipple shield. Rather, the nipple shield was introduced because the baby had a latching problem.

References

Brigham M. Mothers' reports of the outcome of nipple shield use. J Hum Lact. 1996 Dec;12(4):291-7

Eglash A, Ziemer AL, Chevalier A. Health professionals' attitudes and use of nipple shields for breastfeeding women. Breastfeed Med. 2010 Aug;5(4):147-51

Ekström A, Abrahamsson H, Eriksson RM, et al. Women's use of nipple shields. Their influence on breastfeeding duration after a process-oriented education for health professionals. Breastfeed Med. 2014 Nov;9(9):458-66