The dilemma of nipple shields is not only one of what to do with the BABY - but how to address the MOTHER!

I am hesitant to promote the idea that shields should be locked - even though I agree that there is a great deal of risk for their over-use - as there is a great deal of risk to overuse pumps, formula, bottles and pacifiers.

However, I have also been in the situation where the mom, despite education and support and seeing the baby get milk from a spoon, says - I HAVE to know my baby can bottle feed, if he can't breastfeed and I'm going home.  ...and in fact, I agree - I have to know that this baby can eat - and they are discharged so quickly that we rarely get to "wake the baby up"...

The use of a nipple shield should be monitored just like the use of bottles and pacifiers - with an eye to "quality improvement" by reducing their use except when necessary.  Providing staff training, asking for the rationale for their use, and letting staff know that their use is not without negative consequences is important.

HOWEVER - like a pump - they have their place, rescue breastfeeding in all sorts of situations - from the biological "baby won't latch" to the psychological "I'm afraid the baby can't latch" I have found them to be indispensible.  

Sometimes I give moms the shields as a "just in case" and they end up being kept in the packaging because she and the baby have figured it out.  Sometimes she uses it on just the more difficult side, and sometimes she uses it (in my view) unnecessarily - but it HAS kept her breastfeeding and milk has been removed from the breast and now I can work with her to reduce and stop its use...

There are a lot worse things that could have happened, in my view!

Jeanette Panchula, BSW, RN, PHN, IBCLC
California, USA

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