Brooke, I don't have an evidence-based answer, but my personal view is that,
if the baby is gaining, the mother is comfortable during feeds, and the baby
is really resistant to change - then why change?  It may be possible to do
so later, espec if discontinuing the shield isn't made a battleground,
leading to more resistance.  If use of the shield continues, while it's not
quite the same as being nurtured at a bare breast, the baby is at least *at
breast*.  This eliminates bottle use and the extra work and the distancing
of mother and baby.  It can also mean a great deal to the mother of a baby
who won't latch, but will with a shield, to see her milk going into her
baby.  The shield also allows more skin-to-skin, with the baby rolled over
towards the mother, than would happen if they were using a bottle instead.

 

For many years I didn't recommend nipple shields, starting back in the days
when they were thicker and milk flow was reduced.  Then, one afternoon I had
a mother and non-latching baby and she would have quit trying that night had
I not taken my one and only nipple shield out of the cupboard.  It was a
thick, latex one, but it was the only one I had.  It also happened to be a
good fit for this mother. (This type can be a bad fit for others.)  I showed
her how to apply the shield, the baby boy went onto the shield - and the
mother's MER gushed.  The tension went out of her and she was so happy.  I
sent her to a pharmacy to get a thinner shield, and over the next few days
we discussed by phone gradually transitioning to the bare breast.  She
continued to breastfeed.  This experience taught me to be open to using a
shield when other techniques don't work.  Even so, I use them very seldom.
If this happens, we discuss watching for milk transfer and growth, and what
to do if there is any growth faltering.  This is unlikely with the thin,
silicone types, but we discuss how to increase stimulation and boost supply,
anyway.

 

When a mother who comes to me already using a shield asks me about
discontinuation, my goal is to take the pressure off her.  It may be that
she has set herself a time-line and may set herself up for failure if that
doesn't work.  So I look closely at how the baby is progressing and what is
going right for them, and introduce the idea of a flexible approach.  We
look at what for her might be the worst-case scenario (i.e. always using the
shield), and whether that is really all that bad.  By addressing this fear,
and letting her give herself permission to continue, the mother is often
more relaxed about the issue.  She is more confident that she can try from
time to time and, if the baby resists (that day at that time), she can try
again at other times.  I guess that also means focusing on the baby and
her/his readiness, rather than focusing on the shield.

 

PS. I have just read Joylyn Souter's response - which says much the same as
I'm saying, only better and more succinctly.

 

I'll be "no mail" for the next few weeks.

 

Virginia

 

Dr Virginia Thorley, OAM, PhD, IBCLC, FILCA, GDC 

Brisbane, Qld, Australia 

E: [log in to unmask] 

 

On Fri, 8 Jan 2010 Brooke in northern California wrote:

Is there an evidence-based answer to when and if one needs to wean from a
nipple shield. If baby is thriving and mom is content, is there any rush?
Are there any documented negative effects of using a shield for an extended
period of time--or even for the duration of breastfeeding? I know in the
past that the old-school shields caused milk-transfer issues and led to a
lot of poor infant weight gain. But I am wondering about the newer silicone
shields. ..

Beyond the obvious psychological and aesthetic benefits of being able to
nurse without a shield, I'm wondering if there are any concrete reasons why
a mother should wean her baby from them if she doesn't want to. And if so,
at what point is ideal.

 

 

 


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