Have you ever heard of or used a nipple shield? If so, you might have heard some strong opinions like “nipple shields are absolute lifesavers!” or “nipple shields will ruin your milk supply!” Some lactation consultants avoid nipple shields like the plague and others hand them out like candy… it can be hard to know if and when you may benefit from one!
What exactly is a nipple shield?
A nipple shield is a piece of ultra-thin, flexible silicone with a few holes in it that is worn over the nipple and areola while you are breastfeeding in order to help baby latch. Many nipple shields have a cut-out in the base, to allow for more of the breast to be in skin-to-skin contact with the baby while breastfeeding. They come with a plastic carrying case so you can keep track of them (though I recommend having multiple pairs on hand just in case!) and they are easy to clean with soapy water.
One thing that some people might not know is that there are different shapes and different sizes of nipple shields! Some are more pointed and some are more round, or cherry-shaped. The number of holes where the milk comes out even varies between brands! If you are given a nipple shield in the hospital, chances are it is the Medela Contact Nipple Shield, but there are other brands available that you can purchase yourself or that might be recommended if you see a lactation consultant at home, after you are discharged. Nipple shields are definitely not one-size-and-shape-fits-all!
Unfortunately, many families are handed a nipple shield in the hospital with no instructions for use and no follow-up. If you are using a nipple shield, an IBCLC lactation consultant should show you how to use it and explain why it is being recommended AND should go over how to wean off of it (if you are able to and want to). Most importantly, your lactation consultant should be helping you address the root cause of why the shield is needed.
Who might benefit from a nipple shield?
Nipple shields can be a wonderful tool for keeping baby at the breast when they are having latching issues. Some cases I have seen them be helpful for or recommended them for are:
- moms with inverted nipples
- premature babies
- babies who have been frequently fed by bottle who have developed a bottle preference
Of course, these are not the only reasons to use one, just the most frequent that I see in my practice.
What about flat nipples? You may assume that because your nipples appear flat, that you will need a nipple shield. But remember, for an optimal latch, baby should be taking in a large mouthful of breast, not just latch onto the tip of the nipple. So often times, baby can latch just fine with good positioning and the nipple will pop out more with that stimulation. So I always recommend trying to latch without the shield, first, before assuming that you will need to use one.
What about sore nipples? Because a nipple shield creates a barrier between baby’s mouth and the nipple, it is easy to assume that it will help with pain you may be experiencing while breastfeeding. While it might ease some of the discomfort, it is important to get to the bottom of WHY the pain is happening in the first place and to take measures to heal any damage that has occurred. If using a shield because of sore nipples or nipple damage, we want to be sure to continue to work on a deep, effective latch with the shield, to avoid any further damage from occurring.
What are some issues to be aware of when using a nipple shield?
A shield can serve as a bandaid to a problem by helping baby to latch, but it doesn’t address the root cause of the issues that are going on. When we use a shield as a bandaid without working on why there are latching issues in the first place, the baby might not get enough breast milk, or we might see a decrease in milk supply or run into issues like plugged ducts or mastitis.
This is why it is extremely important to work with an IBCLC so you can create an individualized plan that works for you and your baby. We want to be sure that baby gets enough milk and that we are taking measures to protect your milk supply while working on latching.
The risk of a decrease in milk supply happens when the milk transfer from your breast to the baby is low, like when baby is not feeding effectively. So if baby is having trouble latching and you are using the shield, it may be necessary to use your breast pump, as well. If baby is not feeding effectively (with or without the shield), and you do not pump, your supply will decrease over time. Again, be sure to work with an IBCLC for some help with how to navigate all of this!
Remember, it is so important to be aware of WHY the nipple shield is needed. Is the baby having trouble because of a simple fix like some positioning modifications at the breast? Is he having trouble because of a tongue tie? Is mom’s breast so engorged that it is making it difficult to latch on? Has the baby been mostly bottle fed and is trying to transition to the breast?
As you can see, there are many different reasons why a baby might be having trouble latching directly to the breast, so the solution of “just use a nipple shield” is not entirely helpful advice. For example, the plan of care would be different for a baby with a tongue tie than it would for a baby who is learning to nurse after being bottle fed.
Weaning from a nipple shield.
When your baby is proficiently feeding with a nipple shield, your milk production is adequate, and baby’s weight gain is good, you may want to start thinking about trying to latch without it. However, if you do not mind using the shield and things are going well, you don’t HAVE to stop using it. Some moms prefer to not have to have it with them all of the time or worry about losing it or keeping it clean, and others don’t mind it so much.
I will be honest- sometimes the shield can be hard to wean from! If you try to latch baby without it and you and/or baby become frustrated, just put the shield on and try again at another feed. It is usually a slow and steady process. Here are some general tips:
- Start the feed with the nipple shield and after a few minutes, unlatch baby, take the shield off, then re-latch.
- Start on the first side with the nipple shield then when you switch sides, try latching without it.
- Try latching without the shield at night, when baby is more drowsy.
- Roll your nipple between your thumb and forefinger to help evert it a bit before latching.
- Support your breast in your hand using a “C” or “U” shape to make it a bit firmer.
- Don’t ever cut a nipple shield, as this can leave the edges of it sharp.
Using a nipple shield is a completely individual choice. Sometimes, the use of a nipple shield is the difference between continuing a breastfeeding journey or not. A 2009 study of 54 mother-infant dyads found that most (89.8%) of the women reported a positive experience with nipple shield use and 67.3% of the women reported that the nipple shield helped prevent them from stopping breastfeeding (Chertok, 2009). Amazing!
I once had a client who had been exclusively pumping for six weeks. She reached out to me for help because she was not enjoying pumping and she was on the verge of quitting altogether. We tried a shield and her little one latched right away! (Disclaimer: of course this is one family’s experience, your experience might not be the same). For this mom, she preferred the shield over pumping and was able to provide breastmilk for a longer period of time. For some of my other clients, they prefer pumping and giving bottles over using the shield. There is no “right” way to go about things. Each breastfeeding experience is completely unique, and what works for one family might not be the best choice for another.
As you can see, there are many factors to consider when using a nipple shield and you will be most successful if you have someone to help guide you in the process. The most important thing is that you get individualized, knowledgeable, compassionate support from a lactation consultant. If you are using a nipple shield and have questions, or if you think a nipple shield might be helpful for you and your baby, reach out to one of our IBCLCs for a consultation.
Chertok IR. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs. 2009 Nov;18(21):2949-55. doi: 10.1111/j.1365-2702.2009.02912.x. Epub 2009 Sep 4. PMID: 19735341.