I strongly suspect that women with large base diameter nipples are
over-represented in the population of mothers who consult LCs (i.e. women
with problems). The maternal nipple must not be so large that it cannot pass
between the gums of the baby.  It can't be so long that it gags the baby.
And it must be compressible enough that the baby's lower jaw and tongue can
thin it to about half its resting diameter by mashing it up against the hard
palate.  Visualize a bulb syringe:  if you don't give it a great, deep
squeeze, you won't get a bit squirt.  Same with the breast tissue that the
baby must draw into the mouth and milk.

Breastfeeding is such a stable biological activity that generally more than
one thing has to go wrong before it really screws up.  So when a baby can't
latch or a mother has some kind of breastfeeding problem, usually there are
3 or 4 or more things going on -- all of which have to be identified and
addressed.  I will wager that if we looked closely, many of these moms have
large diameter nipples and that these nipples are part of the problem.
Having larger diameter nipple shields won't really help. The nipples will
fit better inside the shield, but the baby won't be any more able to
compress a large nipple with a large shield on it than they could without
the shield.  There also will be an added risk that the larger shields will
create problems.  Their length may gag the baby and create feeding aversion.
Because they are so cavernous, the baby has to be really strong in order to
be able to pull the nipple up far enough inside the teat cavity to grab it.
Otherwise they are just sucking on a hollow teat, and it is like nursing
with a bottle nipple.  In fact, I have long speculated that the use of the
wrong size (i.e. large size) shield is why so many shield users do have bad
outcomes.  I think only the small shields work because they aren't out-sized
for the baby's mouth. And perhaps there are better outcomes precisely
because the smaller diameter nipple is easier to manipulate. If mom has too
large of a nipple diameter to fit the small size shield, the shield is prob.
not going to be the tool that will work for her.  The exception would be if
the baby is really large, or older, and the shield is just a quick bridging
tool to simulate the bottle teat in order to get the baby to latch.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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