The topic of nipple shields is near and dear to my heart b/c of my
personal experience with my first baby. I felt the there was a lot of
contradictory information/instructions/research floating around and I
didn't know what to believe. Follow up protocol was also pretty
nonexistent. I'd love to see what the current recommendations are.
I'm also going to piggyback on this post with my own nipple shield
question:
I got a call a few days ago about a 4 month old baby who is waking
every 45-60 minutes at night to nurse and the mother is starting to
feel very stressed out from lack of sleep (understandably so!). Over
the course of the conversation, it came out that she's been using
nipple shields since the baby was 3 days old due to severe,
unidentified nipple pain.
Here's the information that I have:
1. First time mother, 37 years old. She has a history of fertility
problems but I don't know if the baby was conceived naturally or by in
vitro.
2. Baby was born healthy & full term but via emergency c-section. Birth
weight around 9 lbs, Apgar 10. Baby is currently 17 lbs (gaining about
8 oz per week)
3. Baby latched on "fine" in the hospital, although after 24 hours the
LC there told her that she had blisters on her nipples. No pain, no
cracks, no bleeding.
4. After coming home, mother was having severe, toe-curling pain at
every feeding, so her husband got nipple shields at a baby store. Still
no cracks or bleeding or signs of trauma on the nipples. Use of shields
eliminated pain. Mother never saw a lactation consultant after leaving
the hospital, has received no guidance on use or discontinuation of
nipple shields.
5. Mother not currently pumping, baby receives no supplements. Milk
supply seems good (looking at baby's weight gain) and mother reports
that when baby comes off the breast, she sees milk spraying into the
nipple shield.
6. In earlier months, baby did receive occasional bottles of expressed
milk. Around 3 months (I think?), he started refusing all bottles.
7. Mother had been trying to nurse w/o nipple shield once every few
days. At the same time that baby started refusing bottles, he also
started refusing to breastfeed w/o the shield. He will cry, arch his
back, and refuse to latch on the mother's nipple.
8. Prior to refusal, when mother took off nipple shield, baby would
latch on and nurse "fine." Mother did not have pain at the initial
shield-less feeding, but a few hours later or the next day, if she did
another feeding w/o shield, the nipple pain would return and it would
then be too painful to nurse unless she put the shield back on.
9. Mother has fairly large breasts but very small nipples (self
described as "pencil erasers") which she feels is the cause of baby's
latch problems. Since my nipples are even smaller than that, and flat
as well, and I had one baby who wouldn't latch on and one who latched
on great, I don't agree that nipple anatomy is the problem. I tried to
reassure her of that, but I felt very sympathetic as, with my first
baby, I was also absolutely convinced that my nipples were entirely to
blame for my breastfeeding problems. And when you are living with the
reality of a baby who won't latch on, it's not very comforting to hear
that theoretical future babies might not have a problem! But, I still
tried to emphasize the fact that nipple anatomy probably isn't the
issue. I know in my case, and I think possibly in hers, when you get so
focused on blaming your nipples, you might ignore the possibility of
other problems that are affecting the course of breastfeeding, and that
might be more correctable than nipple anatomy, which really can't be
changed.
I've been trying to analyze myself in terms of why I am so concerned
about this mother's use of nipple shields when I used them myself for
2-3 months (which at the time was the longest I ever knew of anyone
using them). I think it's mainly because she hasn't seen a lactation
consultant and ruled out any other problems (such as tongue tie in the
baby). As much as I felt at the time that I was stumbling in the dark,
and as much as I worried day and night that the shields would damage my
milk supply (according to research I read at the time), I did see a
lactation consultant several times and got some guidance, help in
learning how to latch the baby w/o the shields, reassurance that my
milk supply was fine, etc. I tried to gently suggest to the mother (and
I think she really got it) that even though the use of nipple shields
isn't "wrong," it could be masking some other problem by eliminating
the symptom (the nipple pain) but not whatever was causing the pain in
the first place. Also, I think they are a complicating factor in the
presenting problem (frequent night waking) because even though mother
often co-sleeps, she has to wake up enough to put on the shield every
hour all night long, switch the shield from side to side, etc. I also
suggested if there was some underlying, undiagnosed issue, that could
also be a factor in the baby's night waking. We did speak about making
sure the baby gets plenty of hindmilk, etc., but she felt that the
night nursing was more of a comfort thing than a hunger thing. Mother
is at home during the day, so reverse-cycling seems unlikely, although
baby does not nurse as often (approx. every 2-4 hours) during the day.
Mother is clearly very committed to breastfeeding, but nipple shields
are impinging on her breastfeeding experience; in addition the the
extra work they make at night, she mentioned that she finds it
difficult to nurse in public b/c of the shields and therefore she
doesn't go out as much as she'd like.
Thankfully, she was scheduled to visit a breastfeeding center (this is
somewhere in Seattle) 2 days after we spoke, or I'd have suggested that
she see an LC immediately! She had already taken the baby to the
pediatrician who did not find anything wrong. I told her to be sure to
ask the LCs at the center about tongue tie. I hope she will check in
with me again soon; if so, I will update you all. In any case, any
thoughts or advice from your collective wisdom would be great.
Jennifer Sokolow
LLL Leader Applicant
Long Island, NY
On Feb 7, 2007, at 9:19 PM, LACTNET automatic digest system wrote:
> From: "Laura Hart, RN, BSN, IBCLC" <[log in to unmask]>
> Date: February 7, 2007 7:04:07 PM EST
> Subject: follow up protocol for nipple shield
>
>
> Hello Lactnetters,
> What type of instructions & follow up protocol do you have for women
> who use nipple shields. We have some various opinions & wonder what is
> current evidence-based practice. We are in a hospital setting-
> inpatients & outpatients.
>
> Thank you,
> Laura Hart
> Winter Park, Florida
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