I agree with Kathy Rubin that nipple shields tend to get used
inappropriately if too available in hospitals. However, I have had success
with mothers using shields on a number of occasions. The most important
thing to check is that baby is attaching properly when on the shield, and
not "bottle" sucking only the cone shaped section. This latter situation, I
think, is the origin of the "nipple shields reduce stimulation and
therefore supply" in many cases, especially with nipple confused babies.
The important thing is that baby is actually getting the milk, and
compressing the sinuses efficiently. If he is not attached properly, he
will just be "dummy" or bottle sucking on it and not getting much of the
milk. Then the majority of the milk stays in the breast, causing reduction
in supply (from autocrine control of synthesis of milk) and a hungry baby.
I don't think the issue here is lack of *stimulation* because of the layer
of plastic, as many people infer, rather the lack of efficient transfer of
milk from breast to baby.

If baby attaches well (and looks in the same position as if the shield is
not there) and you can hear lots of gulping and swallowing, then using a
shield is usually OK. You still have, of course, the potential problem of
baby getting "hooked" on the feel of the plastic, and not wanting to switch
to the soft skin of the breast. However, in many cases this problem has not
arisen. I have seen a shield work very successfully with mums who have flat
nipples and have a lot of trouble getting baby to attach and get very
stressed out (as does baby). It's often a psychological thing - if baby
doesn't attach in the first few tries, it's there to use. This relaxes the
mum incredibly, so that the chances of attachment without the shield are
higher. Some feeds go well without the shield while at others she needs it,
until baby is totally on feeds without the shield.

In my opinion, trying shields is often preferable to expressing and feeding
by alternate methods, but each situation needs to be individually assessed.
Many mothers find expressing, etc too tedious and are more likely to give
up totally. At least when using the shield, mum is still "breastfeeding"
the baby. Of course it is important to closely monitor mum and baby while a
shield is being used, to check that baby is feeding efficiently.

Joy Anderson IBCLC, NMAA Breastfeeding Counsellor,
Perth, Western Australia
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