Nikki writes:

<Would someone please explain how making a large nipple larger, (by putting
a shield over it) will help a baby to grasp the breast better?

It makes no sense to me.>

Well, Nikki, since I was one of the persons who mentioned this, I'll explain my logic.

With no measurements of mom's nipple to go by, I went on the theory of "oroboobular disproportion" as Diane Francis, I believe, used to call it. 


In premies with small mouths that are unable to fully "engulf" their mom's nipple, Paula Meier's research concluded that a nipple shield helped those babies remove more milk than when these same babies were attempting to nurse on the that same bare nipple. (I am thinking the mother/baby couples served as their own controls.) 


Although I don't remember her giving any such explanation as I am about to give, my supposition was that when the babies applied suction to whatever depth of the shield they could manage, as a result of the vacuum, the nipple and areola pushed forward into the shield enough so that the rather firm silicone circular junction between the "outgoing" part of the shield and the "flat-against-the-skin" portion of the shield was just at the right place that the mothers' lactiferous sinuses could press themselves against it. This small amount of pressure against the sinuses, coupled with any MER, (I surmised) then resulted in some measurably larger amount of milk exiting the nipple and through the shield.


However, I admit it was just a stab in the dark, because from the description of the "lightbulb" nipples, there is no standard shield available that could have provided resistance of that circular area for the lactiferous sinuses to push themselves against, unless her sinuses were very close to the base of the nipple. I do remember seeing one mother years ago with nipples large enough to "droop over forward" when she was lying on her back. She was the only mother I ever remember discovering lactiferous sinuses within the nipple itself, just "inside" of the base of the nipple itself, and not back 1-3 cm. from the nipple base somewhere deeper under the areola. 


I remember the old glass and rubber nipple shields of decades ago, where the glass base had a larger opening and was shaped somewhat like a pump flange. Since back then all babies were given 3 feedings of glucose water with a rubber nipple in the nursery before coming out to their moms at 24 hours for their first breastfeedings, "nipple confusion" was a term yet to be invented;-) Somehow, I can't think of those shields as "all bad" because the moms nipple didn't hurt and you could see when milk was in fact being transferred. Just think - if I had thought to ask for one for my nipple discomfort and damage, I might have succeeded nursing my first three children and never been so impressed with the frightfulness of the experience of sore nipples as I am, and so might never even have become especially interested in helping other new moms avoid that experience!!! I thank heavens that LLL was established by the time my fourth child was born, and I still remember the name of my "angel on the phone for 9 days in a row". (Our story is in the "vignette" that precedes chapter 7 in the latest edition of WABF.) 


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC    Dayton OH

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