Dear Lactnet Friends:
The prolactin receptor sites need to be emptied of progesterone and filled
with prolactin during the early postpartum for the mother's milk supply to
be sufficient for her 4 or 5 month old baby.
Anne C. McKechnie and Anne Eglash MD, wrote a lovely review article about
nipple shields (< https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014757/>)
"
Nipple shields have become commonplace in the United States for a wide
range of breastfeeding problems. This article is a summary of the current
literature describing the evidence for nipple shield use. The authors
reviewed all available articles on nipple shields and selected 13 studies
for inclusion. The studies were organized into three categories:
physiologic responses, premature infants, and mothers' experiences. This
review concludes that current published research does not provide evidence
for safety or effectiveness of contemporary nipple shield use.
"
It is interesting to note that Paula Meier's research that is oft-cited as
support for their use was done on sample of 34 preterm infants whose
mothers were pump-dependent. In other words, the pump was driving the
supply, not the baby. (And, the study was partly funded and Medela, who
just happens to make nipple shields.) Each baby received a pre and
post-weight check after 2 feeds: one with a shield and one without. In it,
shields are recommended to be used *temporarily*.
https://www.nature.com/articles/pr19991819
A more recent article, done in a BabyFriendly hospital, showed that mothers
given shields were happy, but they didn't breastfeed any longer and weaned
for similar reasons to mothers not using shields:."decreased milk supply,
return to work, concern about baby’s weight, baby preferred artificial
milk, breast infection, inconvenience, discomfort, met breastfeeding
goal." (A description of breast-feeding outcomes among US mothers using
nipple shields. Hanna et al. Midwifery 2013; 616-621)
Chertok's study is oft-cited to support their use in the early postpartum,
but if you look in the tables of her study, half of the babies were also
being formula-fed in the first few weeks. That's a common trait in much of
the nipple shield research; neither duration nor exclusivity are optimal.
Having worked with clients with diminished supply who given nipple shields
in the hospital without additional pumping has led me to to recommend
pumping 3-4 times a day in addition to breastfeeding in the first few
weeks. Pre and post-feed weights can be measured with the shield in place;
what a lovely idea.
In my city, I've heard from clients and nurses that shields are sometimes
given out on the delivery room table. What a poor substitute for supportive
care and time.
As with any tool, they have their abuse and their appropriate use. I feel
they are used to make breastfeeding happen; it's easier to force a baby to
breast when the nipple is made into a bottle teat.
If she goes home from the hospital using one, she should also be hand
expressing or pumping, and working with a lactation professional.
warmly,
--
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Reviews Editor,* Clinical Lactation*
www.nikkileehealth.com
https://www.facebook.com/nikkileehealth
*Communications are confidential and meant only for whom they are
addressed.*
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