Mary asks: Do you think a Nipple Shield should be used  at all in  the first 
2-3 days of life?

 
Well, I would like to rephrase this question to not, IF we should use  
shields in the first few days of life, but WHEN will a shield be a helpful tool  for 
a mother and baby in the first few days of breastfeeding?  
 
I think that the mother-baby connection, milk supply stimulation, and  
feeding baby effectively without use of formula is too important to not use  a 
shield when it will help to accomplish this.  For these reasons,  I will frequently 
try a nipple shield in the first few days after birth --- even  at the first 
feeding --- if I think it will enable a baby to maintain latch and  sustain a 
more effective suck than without it.  After 14+  years of working with 
breastfeeding difficulties, it is rare that I cannot  get a rooting baby latched.  
However, they don't always suck well  enough to be effectively feeding.  Or, a 
mother may need more practice  to be able to do what needs to be done by 
herself to help her baby suck  better.  In these cases, I have seen improved sucking 
bursts and milk  transfer when using the shield.  I think it works sometimes  
like training wheels on a bike, letting mom and baby practice in as close to  
normal breastfeeding as possible until they get better at it and no longer 
need  it.  
 
When I have days at the hospital where it seems too many moms are  starting 
out on shields, I remind myself that I am not seeing normal  newborn babies and 
mothers.  I am seeing babies and moms affected by drugs,  separation, their 
culture, and stress from the way we do birth here in the  USA.  These full-term 
babies, many times, are sucking just like  premature babies.  Their suck is 
weak and disorganized and the  sucking bursts are too brief to get enough milk. 
 As the research shows  with premature babies, I believe these babies also 
transfer milk better  when the shield assists their ability to sustain suck.  
And, like premature babies, when the baby's energy, suck strength  and 
coordination is improved enough,  it isn't hard to wean off the  shield.  Many times we 
can abandon the shield before discharge at  48-72 hours because mom and baby 
have practiced and have recovered enough.   If not, we go over how to know 
baby is getting enough and to call for an  appointment if the shield is still 
needed after a week.  (Though  uncommon, I have worked with a few cases that took 
over a month until baby could  do every feeding without the shield.  
Follow-up with test-weighs  to compare intake with and without the shield help me in 
deciding  how fast and hard to get rid of the shield.) 
 
I think we have to be careful in our position as LCs not to make  absolute 
rules like never using a shield in the first few days.  Our  job is to evaluate 
each mother-baby couplet and figure out with them what is  going to be the 
best way to manage their breastfeeding challenges.  We  limit our resources and 
ability to adapt when we believe one way will always  work and another way will 
always fail.  I also  believe hospital LCs limit help for their mothers when 
they limit the  nursing staff's access to tools like the nipple shield.  
(Unless, of  course, we have a skilled IBCLC there 24 hours every day of the year 
available  for every feeding time having trouble.)  Yes, the staff may use 
tools  too much or too little as they learn.  But, isn't that how most of us have  
learned what helps and what doesn't help in a given situation ---  along  
with good in-services?  If a baby (or mom) doesn't need a shield,  and we know 
how to teach our breastfeeding techniques, then getting rid of the  shield at 
another feeding isn't hard.  Even the experienced staff  nurses can manage this 
when the baby is ready!  If baby can't do well  without the shield, then we 
need to look for the reason the shield is  helping and provide a plan and 
follow-up accordingly.  
 
I have seen the literature change over the years.  The concerns  about milk 
supply and inability to eventually wean off the shield are based on  very 
little if any research, pumping with a shield, and use of the  older shields.  We 
now have research on premature babies and case  studies on the helpful use of 
the newer nipple shields (Start with lactnet  archives, JHL archives 
(especially the nipple shield issue in  the mid-90s),  and the NEWEST editions of 
Riordan's Breastfeeding and  Human Lactation, Wilson-Clay & Hoover's Breastfeeding 
Atlas, and  LLLI's Breastfeeding Answer Book, and then look at their references 
for  more primary ones).  We now have different size shields available and  
the ability to do test-weights to document feeding amounts with  breastfeeding 
(usually for after the mature milk is coming in) along with  recognizing other 
signs of adequate intake from the beginning.  I expect  the trend of 
acceptance will continue as we learn more about how shields work,  actually do 
research on its use in the first few days of life, and increase  our skill in 
recognizing and solving problems with breastfeeding over  time.  Or, if I really 
dream big, we will have a world where most  births are uncomplicated and 
unmedicated and  babies can suck!
 
Natalie Shenk, BS, IBCLC
Findlay Ohio USA





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