When & How to Use a Nipple Shield

Nipple shields have changed over the years.  You will find videos and images of rubber or latex nipple shields which are no longer used due to their thickness. Latex is also no longer used since it has a tendency to break down, has a smell and a taste and is an allergen to some.

Modern nipple shields are silicone.  Medela even made them with a cut-out which was supposed to be used for more skin to skin contact with the baby's chin or if flipped the other direction to prevent possibly obstructing the infants airway.  Since these "contact" style have less surface area, they do not adhere as well as a full circle design such as the Ameda Nipple Shield.

When is the use of a nipple shield indicated?

1.  When a mom has an inverted nipple and the baby does not latch or suck because it does not feel the nipple in its mouth.  Some nipples are easily identified as inverted, but others only invert when the baby tries to latch.  An easy test for this is to take your index finger and thumb and compress the areola 1" behind the nipple.  If the nipple goes in, it is indeed flat or inverted even if it appears to protrude upon inspection.

2.  When a mom has a flat nipple or a nipple that "hides" when compressed as explained above.

3.  When a baby is bottle confused and does not identify a fleshy nipple as it's trigger to suck.  Depending on how long the baby is on a bottle, moms can train the infant to go from bottle to nipple shield and then to breast in the following steps:
     a.  For the first 24 hours, use a wide mouth bottle nipple on the baby's bottle, but turn the baby in tummy to tummy held tightly to feed.  Babies who are used to feeding on their backs tend to fight you when you hold them tightly at first so this is the first step to getting back to the breast.
     b. Wet the nipple shield with your own expressed milk to help it adhere.  You can even take a syringe and squirt some milk into the tip of the nipple shield so that babies who are used to immediate gratification from a bottle will continue to suck.
     c.  After using the nipple shield to get the baby to feed from the breast, try removing it after the feeding has started.

When should I not use a nipple shield?

A nipple shield is a last resort.  It is not the first thing to try when you have a sore or abraded nipple.  If the nipple is sore, it is most likely a poor latch and that needs to be corrected.  Using a nipple shield for a poor latch is not indicated.  See our blog post on correcting the latch instead because a nipple shield used incorrectly can cause more problems down the road as discussed below.

How long should I use the nipple shield?

Nipple shields were intended for short-term use as a bridge to help a mom with a flat or inverted nipple until the baby has a strong suck.  Or to help a bottle-confused baby nurse at the breast.  This short term should last no more than a few weeks.  It you use a nipple shield for longer than a few days, it is important to pump 2-3 times per day with a good double electric breast pump after feedings.  This will offset the decrease in stimulation and milk supply that a nipple shield can cause. 

How can I wean my baby off the nipple shield?

1.  Try removing the shield after the first 2-3 minutes of the feed.
2.  Try feeding the baby when she is in instinctive mode such as half-asleep or in the bathtub without the nipple shield.
3.  Buy a second nipple shield, invert it and take a sliver off with a clear sharp razor each day until the tip is gone.  Make sure you invert the shield and you do not use the only one you have in case your baby has a bad feeding in the middle of the night.  Inverting the shield before slivering it keeps any uneven edges towards you and not towards the baby.

What if my baby refuses to get rid of the nipple shield?

If the baby refuses to nurse without the nipple shield, it is not the end of the world.  Many moms who did not try a nipple shield for a baby who refused to latch, end up exclusively pumping.  Therefore pumping 2-3 times a day after feeding is much easier than pumping 8 times per day.  Your baby will still benefit from the tooth and jaw development that occurs when they are directly at the breast and of course whether you are pumping or nursing, the benefits of breast milk are immense. 

Best wishes, Mamas!
Tanya

Breastfeeding Secrets Revealed: Position, Hold and Proper Latch

     New moms have told me that they wish they had been given more information on positioning and latch as well as the various holds associated with breastfeeding.  So I have decided to reveal these breastfeeding "secrets" here. 
1.  What is the secret to preparing for breastfeeding?
Holding the breast properly!  The c-hold is the proper way to support the breast when learning to breastfeed and should be practiced by expectant and new mothers because almost every new mom does it incorrectly.  How?  Moms tend to place the thumb on top (correct) but place the bottom fingers in the wrong place.  The bottom fingers need to be near the chest wall.  The index finger usually ends up on the bottom of the areola preventing baby from getting a deep latch.  Whether you are already breastfeeding or still expecting, check your c-hold in a mirror to make sure your fingers are out of the way. Also make sure the flap of your nursing bra is not in the way.  Remember, a new baby cannot support the weight of their own head, let alone your breast so support your breast properly and without hindering the latch.  If you are expectant mom, it is not proper to prepare for breastfeeding by toughening nipples, an antiquated practice that breaks down the keratin layer of the skin and is not helpful.  It is helpful to test nipples for inversion by placing the fingers 1" behind the nipple and gently pinching to see if the nipple inverts, goes flat or protrudes normally.  If it does not, consider using a breast pump to draw out nipples just prior to feeding.  A nipple shield is a last resort as it can cause a decrease in milk supply, but much better than using a bottle.

2.  What is the secret of a good latch? 

We will discuss proper body position in a few moments, but here are the basics of a good deep latch.

          1.  Support the breast in the c-hold discussed earlier.
          2.  Line the baby's nose up with your nipple.
          3.  Use your nipple to tickle the baby's lower lip in a downward motion to elicit the open mouth reflex.
          4.  Wait for a yawn or cry-wide mouth.
          5.  Swoop the baby's entire body towards you.
          6.  Bring the baby's bottom in closer to you.  This will dig in the chin and tilt the head slightly.
          7.  Support the breast for a newborn the entire feeding, but don't forget to relax your shoulders and make sure you have support for your arm as newborns can take 45 minutes to get in 20 minutes of swallowing.

3.  What position is the best to learn to breastfeed? 

The cross-cradle hold gives you the most control, but depending on whether you had a c-section, the football hold may be best for you.  We will address the football hold a little later.  In a proper cross-cradle hold you will hold the baby at the nape of the neck with the hand opposite the breast you are using.  Use a proper c-hold on the breast.  Sit back in the chair, put your feet up on a stationary footrest.  This brings your knees above your hips helping to keep you from the temptation of bringing the breast to the baby.  Always bring the baby to the breast.  Otherwise you end up with a sore back from improperly leaning into the baby.  Latching on in the cross-cradle or any position should be done in a one (1) two (2) motion.  Practice the proper latch techniques previously discussed. 1. Swoop the baby in as soon as you see a yawn or cry-wide mouth.  2.  Pull your elbow towards your ribs bringing the baby's bottom with it.  This draws the baby's bottom close helping him dig in his chin and tilt his head back keeping you from the temptation of pushing the breast tissue away with your thumb.  You shouldn't push down with your thumb as it raises the nipple toward the roof of his mouth causing nipple irritation.  When using a pillow, remember that it is there to support you while supporting the baby.  It is not meant to support the baby without your help, but a nursing pillow is an effective tool to keep mom in the proper position and save her from backache. 

4.  What is the secret to a good football hold? 

Much like the cross cradle hold, mom holds the nape of the baby's neck with her hand, but this time, the same hand on the same side as the breast she is using. Use the c-hold and ensure that the bottom fingers are well below the areola.  Support the breast with your hand or a rolled up burp rag during the entire feeding for a newborn who cannot support the weight of his own head.  Remember that your hand should be on the nape of the neck and not higher on the head for several reasons. One being that baby's tend to arch their back when you touch the top of their head. Sit back in the chair, put your feet up and have a pillow on that side of your lap for support. Your baby should be tucked under your arm like a football. His legs should be in a fetal position or and older baby might have them raised up resting his bottom and legs on the back of the chair. done in a one (1) two (2) motion. Practice the proper latch techniques and the swoop and tuck motion previously discussed.   Nursing pillows are essential in this position unless you have a very wide soft armrest on your chair.



5.  What is the secret to when the cradle hold should be used?
It is best to use the cross-cradle hold instead of the cradle hold when you are first learning to breastfeed because you have more control over the position of the baby's head with your hand than you do in the crook of the elbow.  But many moms are very comfortable in this position so moving to this position after the initial latch on as long as you support the breast for the newborn with a rolled up burp cloth is easy to accomplish.  Or once the baby has more control over his head or you are a smaller busted mom, you can use the cradle hold comfortably.  Just remember the latch positioning discussed previously.  Baby's nose should be on target with the nipple.  He should be tummy to tummy with mom.  His ears, shoulders and hips should be in a straight line as it is hard to swallow with your head turned.  Also remember to bring baby to the breast and not the other way around and to relax your shoulders and use something to support your arm.

6.  Do I need to learn to nurse lying down?

Is it important to learn the side-lying position?  In a word, YES!  The side lying position can be the answer for a stressed sleep-deprived mom or a mom who wants to increase her milk supply!  The proper technique for the side lying position is to have a pillow or two under your head and a pillow between your knees to stabilize your hips.  Baby's nose is on target with the nipple and the baby is drawn close with moms arm that is under her.  The bicep of this arm is partially used to support the breast for a larger busted mom as well.  Remember in all holds baby is tummy to tummy with you and not lying on his back with his head turned trying to swallow.  The side-lying position is perfect for co-sleeping at night or catching a nap with baby.  Taking your baby to bed with you if you perceive a dip in milk supply is a great way to get a boost as well.  

     Breastfeeding should not hurt!  If you have had previous trauma and are correcting an improper latch, there can be discomfort for the first 30-60 seconds, but then it should subside.  If it does not, break the suction by inserting a clean finger passed the gums and turning.  Then start the latch again from the beginning.  Don't let your toes curl and your teeth clench because you are a good mama.  The milk sinuses where the milk pools are located approximately one inch behind the nipple and not on the nipple for a reason.  The nerve ending are on the nipple.  Pain is telling you that your latch is incorrect.  Once the baby is in proper position with a deep latch, he will get more milk and you will have a more comfortable rewarding breastfeeding experience. 

     For more answers to breastfeeding questions visit our breastfeeding tips page or give us a call at 254-728-3627 9-5 M-F CST.