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  • Writer's pictureMa Doula
    • Jun 5, 2023

Nipple shields

Updated: Sep 12, 2023

A nipple shield is a thin and flexible silicone cover placed over the nipple and areola to assist with breastfeeding. They are usually recommended when a baby doesn’t effectively latch onto the breast within the first two days after birth, or when a mother has flat or inverted nipples. They can also be used to assist with feeding premature babies, when a mother experiences nipple soreness, oversupply, or even to transition from the bottle to the breast (Chow et al., 2015).


Nipple shield doula Melbourne birth postpartum
Source: Australian Breastfeeding Association

The use of nipple shields is quite a controversial topic among lactation experts, as some older studies found an association between nipple shields and reduced breast milk transfer, while more recent data reports successful breastfeeding outcomes (Chow et al., 2015).



Here is a summary of the most recent literature on the topic:


Advantages (Chow et al., 2015):


Nipple shields can:

  • Help prolong and maintain breastfeeding;

  • Help mothers feel a sense of accomplishment and success in their breastfeeding journey;

  • Enhance mother-baby bonding;

  • Be used easily as it is affordable;

  • Assist with immature feeding behaviour in premature babies (i.e: short or ineffective feedings, falling asleep at the breast too fast);

  • Increase the duration and volume of milk consumed for premature babies;

  • Allow babies to draw milk with minimal suction, and therefore improve milk ejection and transfer;

  • Ensure that babies do not detach from the nipple.


Disadvantages:


Nipple shields may:

  • Reduce feeding efficiency (longer non-nutritive portions of the feed and total feed duration) (Coentro et al., 2021);

  • Influence long-term breastfeeding by creating dependence (Kronborg et al., 2017);

  • Increase the chances of early cessation of exclusive breastfeeding (Kronborg et al., 2017);

  • Be ineffective in improving nipple pain (Coentro et al., 2022);

  • Exacerbate nipple pain in some women and increase the chances of developing mastitis (Walker, 2016);

  • Affect infant imprinting if introduced too early (defined as a neurobehavioral development stage in which the baby recognises their mother through oral tactile memory) (Walker, 2016).


Most hospitals in Victoria recommend not to use nipple shields for a long period of time, and that “baby eventually feed directly from the breast and that attempts to do this be made after a week or two of shield use” (Royal Women’s Hospital, 2018). However, it is sometimes easier said than done, as your baby may have gotten used to the nipple shield and become reluctant to feed without it.


Here are some tips that can help you wean off of nipple shields:

  • Try breastfeeding without the shield when you and your baby are both feeling relaxed;

  • Be patient: it may take a few days/weeks to wean off from the shield;

  • Offer as much skin-to-skin contact as possible even when baby is not eating. Skin-to-skin may encourage the baby back to the breast and stimulate hormones that regulate milk supply;

  • Feed your baby “on-demand” and try latching your baby when they are just waking up;

  • If your baby becomes upset when attempting to breastfeed without the shield, begin with the shield and try again without it partway through the feed or towards the end of the feed (you can try to switch it fast when your baby’s eyes close);

  • Do not persist without the shield if your baby becomes upset (so they don’t associate being upset with the breast). Instead, continue using the shield and try again later;

  • Try to hand-express a few drops of milk onto your nipple before trying to latch to encourage baby back to the breast;

  • Talk to your baby while latching and encourage them;

  • Try different breastfeeding positions (e.g football hold);

  • Try making the U shape with your breast when latching your baby;

  • If your nipples are inverted or flat, you can try pumping for a few minutes before latching baby to evert your nipple. You can also use an ice cube or a cold towel to harden your nipple before latching. Some products may also help correct your inverted nipples;

  • Consider making an appointment with a lactation consultant.


In any case, the use of a nipple shield should never be seen as a sign of failure. Some women need extra help to successfully breastfeed, and you are doing the best you can for your baby. If the nipple shield can help you maintain long-term breastfeeding, and if you don’t mind using it, there is no reason to stop.


References:


Chow, S., Chow, R., Popovic, M., Lam, H., Merrick, J., Ventegodt, S. & Popovic, J. (2015). The use of nipple shields: A review. Frontiers in public health, 3, 236.Available at: https://www-ncbi-nlm-nih-gov.elibrary.jcu.edu.au/pmc/articles/PMC4607874/#B16


Coentro, V. S., Perrella, S. L., Lai, C. T., Rea, A., Dymock, M., & Geddes, D. T. (2021). Nipple shield use does not impact sucking dynamics in breastfeeding infants of mothers with nipple pain. European Journal of Pediatrics, 180, 1537-1543. Available at: https://link-springer-com.elibrary.jcu.edu.au/article/10.1007/s00431-020-03901-3


Coentro, V. S., Lai, C. T., Rea, A., Turlach, B., Geddes, D. T., & Perrella, S. L. (2022). Breast Milk Production in Women Who Use Nipple Shields for Persistent Nipple Pain. Journal of Obstetric, Gynecologic & Neonatal Nursing, 51(1), 73-82. Available at: https://www-sciencedirect-com.elibrary.jcu.edu.au/science/article/pii/S0884217521002720


Department of Education and Early Childhood Development (2014), Promoting Breastfeeding, Victorian Breastfeeding guidelines. Available at: https://www.education.vic.gov.au/Documents/childhood/professionals/health/brestfeedguidelines14.pdf


Kronborg, H., Foverskov, E., Nilsson, I., & Maastrup, R. (2017). Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding?. Maternal & child nutrition, 13(1), e12251. Available at: https://www-ncbi-nlm-nih-gov.elibrary.jcu.edu.au/pmc/articles/PMC6866009/#mcn12251-bib-0031


Royal Women’s Hospital (2018), Nipple Shields. Available at: https://www.thewomens.org.au/images/uploads/fact-sheets/Nipple-shields-2018.pdf


Walker, Marsha,R.N., I.B.C.L.C. (2016). Nipple Shields: What We Know, What We Wish We Knew, and How Best to Use Them. Clinical Lactation, 7(3), 100-107. Available at: https://www.proquest.com/docview/1807213911/fulltextPDF/874921396C24466EPQ/1?accountid=16285



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