Nipple shields can be helpful for a variety of breastfeeding issues. Some women only need to use them in the short term, and others find they are a part of their entire breastfeeding journey. Importantly, they do not decrease transfer of milk, as long as baby’s fit and hold is right.
What are they?
Nipple shields are made of thin, soft, flexible silicone and are shaped like a witch’s hat. They are put over the nipple and areola while breastfeeding. They come in a variety of shapes and sizes. Medela would be the most popular choice.
When do you use them?
Nipple shields are often suggested for women that are having pain while breastfeeding. Dr Smith and I would argue that pain during feeding is a sign of poor fit and hold and would encourage anyone using a shield due to pain to come and see us for a breastfeeding consult.
Other reasons include: flat or inverted nipples (as it makes it easier for the baby to find the nipple); baby is small or premature; introducing the breast to a bottle-fed baby and helping to heal nipple trauma while fit and hold is being addressed.
How do you use them?
Simply place the nipple shield over your nipple and areola and hold it against your skin while bringing baby to your breast. The ‘cut out’ part of the nipple shield should be placed where the baby’s nose will rest. (If there are 2 cut out parts, like with the Avent shield, the other one is for baby’s chin). In the Gestalt style of breastfeeding, this will be at 9 o’clock on the right breast and 3 o’clock on the left. Some women may find the shield stays in place better if they stretch the shield while placing it over the nipple, or put some breast milk onto the inside of the shield, or apply some lansinoh to the areola surface of the shield. The baby may be more interested in taking the shield if their is some milk on the outside that they can smell.
How do you get the right size?
Most women will find they get better milk transfer with a larger sized shield. Medela has 3 sizes: small (16 mm), medium (20 mm) and large (24 mm). Small is only ever needed for premature babies. Your nipple should not touch the end of the nipple shield (if it does, it is too small). If you’re not sure – start with the large one and see how you go.
How do you clean them?
They do not need to be sterilised. Rinsing in cold water and washing in warm soapy water and letting them air-dry or dry with paper towel is fine. They can then be stored in their plastic container.
How do you wean off them?
Choose the feeds that are usually the most relaxed to start experimenting with weaning. Often the night time, and sleepier feeds, are the easiest ones to begin with. You may like to start by taking the shield off part way through a feed as the first step. Then try bringing baby to the breast at the start of a feed, without a shield. By bringing the baby’s chin against your breast tissue, this should switch on baby’s feeding reflexes and help them locate the nipple. Expressing some milk before the feed will help to elongate your nipple and start the flow of milk so baby doesn’t have to wait for the let down. Plenty of skin-to-skin time can also help. Feeding in a different position than normal (such as side lying) may also be helpful. If the feed is not going well, go back to the shield and try another time.
If you are having trouble with feeding, or using a shield, please make an appointment with Dr Rhiannon Smith or myself so we can help you out.
by Dr Briony Andrew