In the last 3 weeks, I have had 3 moms using nipple shields in the
hospital. They all had 35-36 week babies, who were sleepy and reluctant
latches. All the babies were around 5 lbs at birth. Two of the moms
had very large breasts, and all had large, flat nipples. Two of the
moms were 16 years old. One was married, but had an over-anxious
family, hovering with a bottle. (I hate it when things come in
streaks. I always think I may be getting into a rut when I use similar
treatments, and question myself as to whether I am appropriately
assessing each situation!)
With the first mom, we worked for a few attempts to try to establish an
effective latch. The baby would not even suck on my finger. Because
the baby was just under 5 lbs., 35 weeks, and sleepy, we began
supplementing with bottles of formula. She began double pumping every 3
hours. I hoped that with some supplementation, the baby would perk-up
and we would be able to get her latched-on. I also thought the pump
would help to pull out the nipple and improve latch possibilities. The
next day, when the baby still would not latch, we started the nipple
shield. The baby went to breast and suckled actively for a time, the
mom followed with a bottle and pumping. She was discharged with this
plan. At five days, her milk was in and the baby was BF with and
sometimes without the nipple shield, but only on one breast. She
continued to pump after feedings. One week later, the baby was BF
without the shield on both breasts, and the mother was only pumping
occasionally. The baby had gained weight and the mom was very happy.
This was a 16 year old mom.
Second mom was married, and family was very anxious about baby's
intake. They started formula at about 24 hours of age (before I got
into the hospital that day). She started double pumping a few times a
day; BF with a nipple shield, for some feedings (when there weren't too
many visitors); and supplementing with a bottle of formula. I
encouraged her efforts. Explained that if she wanted to BF, she needed
to offer the breast and pump regularly. When I called her by phone a
few days after discharge, she was pumping one ounce total per day,
putting the baby to the breast with the shield, and following with the
bottle. At ten days, she reported the baby was nursing at the breast
without the shield. She was still giving some bottles, because she
thought the baby wasn't getting enough. We discussed the need to BF
more than the amount of formula she was feeding, not increase the amount
of formula, and BF twice in a row before offering a bottle, in hopes of
increasing her milk production.
The third Mom was also 16. She was given a nipple shield by her nurse
for the first BF after birth! When I got to see her, it was day of
discharge. I was able to get the baby onto the breast, but did not have
any time to work with her before she went home, so they went home using
the shield. When I followed-up by phone at 6 days of age, the baby was
doing better with breastfeeding and was not using the shield any longer.
Each of these Moms had same and different reasons why the nipple shield
was used. Each had success and getting to direct BF in a short time.
My question, for those who work in hospitals: Where are nipple shields
kept and who has access to them? I would like to be able to assess and
work on latch before they are used, but I am not there 24 hours a day,
seven days a week. In my hospital, they are stored in a Nursery
cupboard where anyone can get them. Nipple shields and breast shells are
both used more than I think necessary. But I am reluctant to lock them
up so that only I have access, if they can help to save the
breastfeeding when I am not there...
Barb Berges BS, RN, IBCLC
Rochester, New York
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