I very much disagree with nipple shield use in those first few days postpartum. We have NO good evidence that a silicone nipple shield will do anything to improve the baby's chances of latching without the shield, nor do we have evidence that the baby will transfer milk well, and that mom will maintain her prolactin level and milk supply using the shield without additional pumping. In fact, the few studies done with very few patients suggest that nipple shields could have a negative effect on lactation. I published a review of nipple shield use in Breastfeeding Medicine 2011, I am happy to share this with any one interested.
The nipple shield is wonderful for nurses because they can give it to the mom, baby will latch, and the nurse does not have to hang around to help the baby latch any further...her job is done. However, I have seen many moms in my lactation clinic who have a low milk supply in relation to using the shield, and many curse the fact that someone told them to use it in the hospital. If mom is given a shield, she will need to do 3 things, that is nurse, pump, then supplement. I prefer, especially early on postpartum that moms do lots of skin to skin and infant-led latch and give the baby a chance!!!! IF the baby won't latch by 24 hours, start supplementing with finger feeding or bottle, and pump regularly. Those are 2 tasks, not 3. And, continue to give the baby more chances!!!
In addition, from my experience infant led latch does not work as well after nipple shield use because the baby looks for a silicone nipple when the baby travels down to the breast. I think using nipple shields early on is like imprinting baby ducklings on decoys. Infant latch is very deeply ingrained in all mammals, humans as well as puppies and kittens. We need to really work on stimulating that infant reflex, not impatiently quashing it.
Anne
Anne Eglash MD, FABM, IBCLC
Clinical Professor
Dept of Family Medicine
Medical Director UW Lactation Clinic
University of Wisconsin School of Medicine and Public Health
600 N. 8th St.
Mount Horeb, WI, 53572
608-437-3064 (O)
608-437-4542 (fax)
608-550-3054 (pager)
Date: Wed, 20 Feb 2013 21:48:35 +0000
From: "Holmes, Barbara"<[log in to unmask]>
Subject: Hospital Policy/Protocol for full term infants that are not latching being introduced to nipple shield
Hi there Lactation Consultants:
I was wondering if any of those of you who work in hospitals have ever created(or had need of creating) a protocol and/or policy for introduction of usage of a nipple shield in the case of a baby who is not latching on(in other words, apart from the research for preemies and LPTers). My supervisor would like me to create one and on the one hand I think it's a good idea but on the other hand I think sometimes someone experienced will find the need to "break their own rule". A year or so ago my co-worker and I were looking for research on nipple shields being used for difficulties breastfeeding and we couldn't find any. It seems as though a lot of the ideas many people had that you should never use a nipple shield came from the old rubber nipple shields that are not used anymore. I do use silicon nipple shields sometimes but I've sort of developed my own protocol(try everything else 1st, give the baby at least 24 hours to latch 1st and then make sure the pt is instructed the proper way to put it on and to pump with a hospital grade pump until there is clear evidence of milk transfer). Is there any research out there about this that anyone knows about that is not out there?
Thanks!
Barbara Holmes MS,RD,IBCLC,CD(DONA)
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