Dear All,

I know that we have had these nipple shield conversations on nipple shield use in the past.

As a family physician, I round on newborns, follow them postpartum, see patients in my lactation clinic, and watch my patients grow up and have their own babies. So, I can say that I have longitudinal care of a population. My population is not wealthy. It is middle America, and several families also attend WIC.

I agree with Nikki that I rarely find a need for a nipple shield. I understand the angst of wanting to help a mom be successful, and a nipple shield is a step that often can make nursing easier. However, informed consent is extremely important. 

Let's first recognize normal physiology. Nipple stimulation is the means by which a mother raises her prolactin level. Unfortunately nipple shields have entered our breastfeeding culture with no good evidence that the prolactin level can be sustained adequately over several weeks/months with nipple shield use. Studies that have been done have very small #s of subjects and are not done over several weeks. So, when you put a cap over the nipple, knowing that nipple sensation is key to successful breastfeeding, you have to prove that this is a safe strategy.

In addition, we don't have evidence that when a baby's mouth has a nipple shield in it, that the baby can also deeply grasp and strip the retroareolar tissue. We just had a wonderful lecture and ultrasound demos from Dr. Woolridge at the Oct 2015 ABM meeting where he reminded us that babies do massage and express breast tissue...they don't just use suction. Small studies on low tone premies over the course of a few days do not suffice to support the claim that milk transfer can be as good or better than without the shield.

So, if a lactation provider is going to recommend a nipple shield it is important to disclose that we don't know the effect of nipple shield use over time on the level of prolactin, and we don't know how well babies transfer milk with a nipple shield. It will be variable. We also don't know how difficult it will be for the baby to go to the breast without the shield because using the shield just taught the baby that mom has firm, silicone nipples. (That is called imprinting)

Ethically, it is wrong to do harm, ie possibly damage the nursing relationship, cause a harm to mom's milk supply, cause the baby to have difficulty latching to the breast over time.

My suggestion is to tell families the following:

The benefit of a nipple shield  is that it might make it easier for the baby to latch.

The risks of a nipple shield include a possible drop in milk supply due to decreased prolactin level, possible insufficient milk transfer, and possible inability to get the baby to latch without the shield in the future.

If a nipple shield is used, the baby needs to be followed by a lactation specialist not just for 1 visit, but at least every few weeks over the course of time, in case the prolactin level is not sustained and supply diminishes over several months.

Mom should be encouraged to pump after nursing with the shield to sustain her supply until it is clear that the baby consistently transfers adequate milk well. However, just be careful that the baby may transfer milk well when mom's supply is high, but if her supply dwindles over time due to a drop in PRL, that milk transfer may wane.



The reason I emphasize all of this is because I have observed clinically over many years many babies that have ended up failure to thrive due to nipple shield use past 2 weeks of age. Mothers were never given informed consent about possible risks of nipple shield use.



Anne







Anne Eglash MD, IBCLC, FABM

Clinical Professor, Dept of Family Medicine

University of Wisconsin School of Medicine and Public Health

Medical Director of UW Health Lactation Services

Co- Medical Director, Mothers Milk Bank of the Western Great Lakes

President of The Milk Mob,  A Gang of Breastfeeding and Human Lactation Educators

www.themilkmob.org

Breastfeeding is Nature’s Health Plan







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