I have very mixed feelings on the topic of Nipple Shields.  As an LC I've seen them be thrown at every known problem, at all times, when in reality the nurse, lactation specialist, or doctor simply didn't know what else to do. 

However, as a Mom with very flat nipples and a baby that wouldn't latch for >24 hours, the nipple shield was a saving grace for me.  After loosing my dream of a natural birth to a scheduled c/s due to breech positioning, I was bound and determined to breastfeed - I couldn't stand the thought of loosing that.  My son tried and tried and tried and we worked with several nurses and the IBCLC at our hospital without success.  I was beyond disappointed... emotionally distraught - a nurse came in once while I was cup feeding and told me to stop, that I would likely kill my baby if we fed that way.  I sobbed because I was so afraid of introducing artificial nipples and she replied that nipple confusion (flow confusion) was entirely untrue - and if I continued in what I was doing our baby would aspirate and die.  I sat sobbing on the bed, my newborn in my arms, in pain from surgery, grieving the loss of the birth I had sooo hoped for, with friends and family telling me none of it mattered (because the only important part was that I had a healthy baby, period).  I had lost the chance to immediately bond with my baby due to the c/s, and now he couldn't latch - I felt like a failure.  The first time we applied the shield, he nursed wonderfully.  It gave me the boost I needed to move forward and keep with it.  It slowly began to restore my confidence that I actually could nurse, and mother, this baby.

I was discharged 5 days pp still using the shield 100% with no instructions for how to wean from it.  I'd been given the instruction to "keep pumping" after each feeding, but my son didn't need to be supplemented with that milk.  I wasn't given information on storage of that milk - even though I was returning to work.  Once I was home, and my milk was in, I pumped after nursing one morning and got more than 4 oz out of each breast!  Since I'd gotten so much, I figured I could stop pumping.  No one told me my supply would be greater in the am, or WHY it would be important for me to continue to pump.  When I told the LC I'd stopped pumping, she told me to pump anyway, but never explained why I should.  When I asked her how to wean from the shield, she said, "Just take it away."  But we struggled each time I tried to latch him without it.  My son nursed with that shield for 8 long weeks!!

I strongly believe we should exercise all options before using a shield.  When they are used, Moms need close monitoring and follow up - and in-person follow up if they are having trouble weaning off the shield.  Shields are a good tool, but only when it's used properly with good guidance and close monitoring.

As I'm in private practice and not inside a hospital, I find my clients have the best success when they've been advised to do lots of STS, baby led latch, pumping and spoon or cup feeding.  By the time they are home and seeing me, they are usually 3 - 4 days pp.  Since I spend much more time with them than an IBCLC at the hospital, sometimes we're able to get baby on at that point.  If not, we'll try a shield and go from there.  But I'm following up with those moms very closely.  Usually within a day or two 100% of feeds are at the breast, at that point I'm back out there helping Mom to wean from that shield as quickly as she can.  So in my practice, Nipple Shields are a short term tool used to treat a specific issue and used to help restore Mom's faltering confidence.  I firmly believe Mom's confidence level is every bit as important as any imprinting on the baby, and each mother-baby couplet must be carefully evaluated to craft the most appropriate care plan.

OK, off my soap box now.  :-)

Have a great day!!
Jillian Malan, LLLL, IBCLC
Michigan

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