In defence of nipple shields

Again this week, I read a comment by a leading breastfeeding expert tutting over the use of nipple shields. 

Of course, this person has decades of experience.

Of course, there are plenty of times when nipple shields are used incorrectly and over-enthusiastically .

Of course, when they are used without seeking access to other breastfeeding support they can mean supply issues, continued nipple pain and damage and a situation that can be challenging to unpick.

But can I please just take one moment to say that sometimes they can be bloody marvellous.

I’m not ‘supposed’ to say that. I’ve heard lactation consultant colleagues say, “Oooh, I hate nipple shields.” I’m meant to be down on them and focus on all the disadvantages.

But sometimes I just feel they need a little bit of defending.

I don’t know what’s going on with tongue tie at the moment. It seems like every breastfeeding drop-in group I visit has at least a third of babies who are post-frenotomy (tongue tie ‘snipping’) or they have been diagnosed and are waiting to be seen. Obviously the proportion of babies who come to get breastfeeding support will inevitably include more struggling with tongue dysfunction - however the numbers still seem ludicrous.

 I’ve seen mums who are breastfeeding several months after an initial nightmare month living with tongue-tie and a nipple shield has made all the difference.  Tongue tie is often accompanied by a high-arched palate or ‘bubble’ palate as when a baby is in utero the tongue hasn’t been pressing up against the soft bone of the palate due to its restriction and the palate doesn’t end up being smoothed into the typical gentle arch. And although babies can feed just fine on flatter nipples and even inverted nipples, they often do like to feel something touching their palate and triggering their sucking reflex. And if that palate is an extra centimetre away, that can be tough.  A baby may struggle to get purchase. They may appear to be searching for something and become frustrated. Finding a way to get baby to latch on and stay on may not always be easy.

Babies with tongue tie and high palates can latch on effectively but it’s not easy for everyone to find those ways on their own.

There are ways to get babies to latch on beautifully to flat nipples but it’s not easy for everyone to find those ways on their own.

In some cases, nipple shields can be a useful tool. The baby receives that palate stimulation and settles into a fabulous rhythm of deep swallows and great chin movements, milk is transferred and it’s hard to see what’s so evil about that.

Those who demonise nipple shields might have talked about the need to ‘work harder’ to find a latch that works. That’s fine - but when it’s 2am and mum is exhausted and baby is exhausted a bottle of formula may well be an appealing choice when your nipples are already sore and feeding has never been easy.

If we make nipple shields the ‘bad guy’, you may find that less feeding happens at the breast. Not everyone has a breastfeeding specialist sitting in the corner of their bedroom behind the nightlight. Or even access to good quality breastfeeding support throughout the week in the day time.

This morning I worked with a mum who had nipples that looked naturally quite different. One had a wide barrel shape and a length of about 15mm. The other was a slight dome rising no more than 3mm above her areola. She had been feeding successfully on one breast but when it came to the flatter side, baby was confused and frustrated. He had never really latched on for more than a few moments. Several weeks on, she was feeling desperate. She had been supported to try many positions by several breastfeeding counsellors and lactation consultants. She had visited a cranial osteopath. But the reality was that her son was used to the sensation of the longer nipple and the other side was less straight forward and he was struggling to move between the two. Perhaps she could only feed from one side and express the other? Perhaps she could just lactate on one side?

She tried a shield today and, for the first time ever, he moved immediately to deep chin movements, audible swallowing and mum said, “Yay!”.

She actually said “Yay!” quite a few times.

I would defy someone who had spent time with that mum and heard her history and worked with her to then say, “I hate nipple shields”.

There are certainly times when they don’t work well. I’ve also been to a group and a mum has shown up using shields to help her cope with sore nipples. The low point came a couple of nights ago and she couldn’t continue feeding  just on the breast. Even in that moment, it’s hard to argue it would’ve been better for her to stop breastfeeding and use a bottle in order to ‘rest’ completely. The shields allowed her to keep going and avoid the complication of using a bottle. However the shields were not her solution. Thankfully she sensed that and knew to come to a group and get support but I wonder how many women don’t. Her positioning and attachment could certainly have done with some improvement. She was leaning forward and ‘offering the breast’ and then pushing it in baby’s mouth without really waiting for a gape or bringing the baby to her. Her nipple was coming out after a feed flattened and compressed and was visibly damaged along the ridge where it was flattened. There were lots of things that could be improved. And the shield didn’t help with any of that. But it helped with her psychology and she came to the group. It kept her going.

Shields don’t help with sore nipples. They can exacerbate issues where babies have insufficient gapes and the baby just then transfers their insufficient gape onto the shield. But if the shield means that mum can cope with breastfeeding until she does manage to get the right support, if they stop her giving up, then that surely is a positive.

Shields are connected to a lower milk supply. Possibly because hormones aren’t being stimulated in quite the same way even through the modern thin silicone shields. Possibly because the people who resort to using the shields have issues that are the true cause of milk supply reduction. It can be wise to stimulate your supply using some additional expression if you are using shields and keep a closer on on baby’s weight gain. However I’ve also seen shields get a mum through a difficult couple of days when she had too MUCH milk. After struggling with oversupply and overactive letdown, her baby choking and spluttering with every feed, she found using the shields tided her over until she was able to get proper support and information. The baby was able to come to the breast without being flooded and her alternative would’ve been expressing and bottlefeeding.

If we demonise nipple shields, we reduce options. Options that actually might help when the next breastfeeding group is in two days time and the breastfeeding helpline isn’t open for the next 10 hours. And when the temptation is to pick up a bottle when it’s really not want you want to do.

You can use a shield and practice good body positioning and nose to nipple and head tilting and gaping. The baby works at the breast and is held close and does lots and lots of useful and valuable things and transfers milk as it gradually thickens and this is all still breastfeeding.

If you’ve been a breastfeeding supporter for a gazillion years and you’ve always managed to get babies to latch on superbly and you’ve never needed to use a shield – that’s dandy. But I will hold my hand up and say that sometimes I’ve worked with mothers who did use a shield and it made them happy and they felt great and the baby felt great. They went on to reach their breastfeeding goals, often weaning off the use of the shield with very little difficulty.

I think sometimes nipple shields deserve a teeny little ‘yay!’ They aren’t right in MOST situations and good quality breastfeeding information usually means that they are not needed.  If they are going to be used, they should be used with support from someone who is qualified in breastfeeding. But in a minority of cases, they can be bloody marvellous.