I find that nipple shields are a useful tool, just as any other tool we have at our disposal. If a mother is going to be using the shield for a significant length of time, I become a little concerned about making sure that all 4 quadrants of the breast are adequately drained and that we do not leave sections of the breast minimally drained for long periods of time. We don't want mastitis on top of any other problems. I always have the mother use alternate massage on each breast when the shield is being used to do the best she can in helping to more thoroughly drain the breast.


One mother I worked with whose baby had tracheomalacia used nipple shields for about 6 months until the baby could handle milk flow without choking. The shield allowed the baby to suck, swallow, and breath around a collapsing trachea- what a challenge!  She fed the baby in a semi-reclining position with the baby positioned ventrally (prone). She would sit forward several times during the feeding leaning down to massage and move milk forward in the breasts. In spite of this, she still got mastitis on one side so I guess I am a little more careful when working with moms using shields.


I use whatever size works best for the particular mother/baby pair.


Marsha Walker, RN, IBCLC
Weston, MA








 

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