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The Shield

By Amalah

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Hi Amy,

I’m a HUGE fan and plan to write you a separate gushing email soon about how your blog and various advice columns got me through my pregnancy. But for now, I have a question, and I’m sorry, it’s really long! It may not be something you can answer, but I thought I’d give it a shot.

Two weeks ago, I gave birth to a beautiful baby girl. I knew I wanted to breastfeed, and for the most part, it’s gone very well. The most important thing is happening — the baby is totally thriving. She’s a voracious eater and was up above her birth weight at her one-week doctor’s checkup, without me having to supplement at all; my supply has been right on target. I am also lucky that both my mother and my mother-in-law breastfed and believe it in strongly, and my husband is a fan as well, so I have a lot of support and encouragement.

My problem is regarding nipple shields. The first time I fed her in the recovery room, she couldn’t get latched on, but I chalked up a lot of that to my position at the time, as I was flat on my back being stitched up after a difficult vaginal birth (forceps, anyone? yes, please, and I’ll have a fourth-degree tear on the side). Then in the postpartum room we tried again. At this point I had been up for about 26 hours and the very pushy nurse popped a nipple shield on me without really explaining why or what it was supposed to do, then put the baby on to feed. I went with it and things went okay in the hospital, although somewhat painful. I asked the lactation consultant who stopped by just before we checked out (and didn’t really seem interested in answering our questions) about it, and she said something like “keep using it until you don’t need to anymore” before leaving.

The next day at the first pediatrician visit, I talked to the lactation consultant there, who informed me that part of the extreme pain I felt when she latched on was probably due to the nipple shield I had being two sizes too small. She brought me a proper fitting one and told me I had inverted nipples, and again said something about working my way off the shield, but didn’t really answer my questions about how and when to do that. Breastfeeding got less painful with the larger shield, but I still felt like something wasn’t right, so I took matters into my own hands and scheduled a home visit with a THIRD lactation consultant from the Breastfeeding Center here in DC. She came over and was lovely, and got the baby to latch on without the shield, which we did successfully a few times. But it still hurt like hell right when she latched on, and that time and the times since that I’ve tried to feed her without the shield (which I have been able to do, and felt very proud of both of us), she’s done a number on my nipples and made subsequent feedings more painful.

The nipple shield was not something covered in the breastfeeding class I took or any of the info that I read, so I felt totally blindsided by it and now like I’m completely dependent on it. The current status is that I’m still using it every feeding, and despite a few seconds of initial pain when she latches that I still have, 1-2 minutes later there’s no pain at all, and the vast majority of the time I spend feeding her is downright pleasant. But while all three lactation consultants have advised me to get off the shield when I can, start by popping it off mid-feeding and get her latched on, etc., none of them will give me a straight answer of what will go wrong if I don’t.

That’s my question for you. Do you know if there are problems with just always using the nipple shield? What could the negative impact be on the baby? On me? Is there a time by which I don’t get off of it, it will cause issues with feeding later or something? This damn piece of silicone has me SO stressed out, and I just don’t feel ready to give it up yet. I may eventually, but for now, (1) my nipples are still raw, (2) my baby has a tiny mouth — she was pretty little and there’s only so much areola she can take in to get a good latch, (3) my baby is also not a patient soul and screams when she’s not fed rightthissecond, and latching without the shield usually takes multiple tries, and (4) I’m still hurting in other places from the delivery and just trying to avoid any extra pain when I can. I feel so guilty when I finish each feeding without even trying to do it without the shield, but I can’t bring myself to let her tear me open again. What would be the downside of waiting until she has a bigger mouth and my nipples are more healed before trying again? Or just using it until I go back to work and she’s drinking pumped milk from a bottle most of the time?

Thanks so much in advance for any advice you have.

~Anonymous

First, let me make one thing super clear: I am not a lactation consultant nor anything close to a breastfeeding expert. I also have zero personal experience with nipple shields or inverted nipples. In summary, I am the most woefully under-qualified person you could possibly take your question to.

Got it? Okay! Now let me ramble on for many more paragraphs.

The Problem With Nipple Shields

From MY understanding, there are two “real” potential problems with long-term nipple shield use, hence all the pressure on you to wean your baby (and yourself) from it: First, they can cause supply problems, as your baby is unable to really suck deeply from your breast. Thus, she doesn’t empty your boob, you produce less milk, you are at a higher risk for clogged ducts and mastitis, oh, joy.

The second problem can crop up when you introduce bottles. Your baby is already accustomed to the taste and feel of a silicone shield, and may more rapidly develop a preference for bottles, as they have the same feel in her mouth but don’t require so much work on her part. As the mother of a kid with oral motor issues, I can attest that yes, this does happen, even without the shield. It’s not insurmountable (I highly recommend using preemie-flow nipples instead of level ones), but combined with supply issues, it’s also not something I’d wave away as not worth worrying about.

Of course, the supply issues/baby not getting all your milk are POTENTIAL problems. It certainly doesn’t sound like you have any, with a chubby thriving baby. If you’re concerned, you can always try pumping for five or 10 minutes after feedings — this way you’re guaranteed to make sure your boobs are empty (less risk of clogged ducts) AND sort-of trick your body into thinking you need to make more milk than you actually do. (And it’s all a balancing act, as you don’t want to veer into oversupply territory either. WTH, boobs.) If your daughter continues to gain weight and thrive, pee and poop after feedings, etc., you are likely making enough and she is likely getting enough, even with the shield.

The other problems I’ve seen listed as “cons” for nipple shields basically amount to: You should wean from nipple shields because it can be incredibly difficult to wean from nipple shields. Um. Okay then.

Dealing With Inverted Nipples

So. Onto the inverted nipple thing. If you aren’t on a hospital-grade breast pump, get one. Watch your boobs in the shield and see if it’s able to draw out the nipple. Even if it can’t at first, from what I’ve read, it can with time, since flat and inverted nipples are often caused by adhesions that need to be broken. (OW. GOD. I AM SORRY.) If you see that the pump can pretty easily draw your nipples out, then it could be time to try going shield-less with your daughter again.

As for the pain: if you are able to get her to latch correctly, the pain WILL decrease and stop once your nipples heal — though there is some overlap. However, if her latch is as bad as you make it sound, you will get trapped in a endless cycle of her mouth inflicting more damage to your nipples as soon as you heal. Waiting until she’s a bit bigger and able to latch correctly (i.e. bypassing the nipple and getting her mouth around the areola instead) before ditching the shield is probably not going to be the end of the world, particularly if you’re using a breast pump to offset any potential supply problems in the meantime. I would probably say it’s still a good idea to occasionally whip the shield off mid-feeding (once your milk is really flowing and she’s really into it), but definitely find some balance so you can stop stressing about this so much. Balance, and a prescription for some All-Purpose Nipple Ointment (APNO). It’s the greatest stuff in the world. (OF ALL TIME!)

(Oh, and has anyone checked her out for a tongue-tie? Little flappy skin thing under her tongue? Have you seen her tongue stick out past her bottom lip? Or does it stay in her mouth and look like the top of a heart? Because MAN, that nonsense HURTS, and makes a good latch all but impossible.)

But…you know, I KNOW of women who never managed to get their babies weaned from the shield. It sometimes is a necessary evil for preemies and inverted nipples (though it sounds like your nurse really jumped the gun by giving you one, but hey, I don’t think you’re allowed to be a breastfeeding mother without having a story about some TERRIFICALLY BAD ADVICE you got from someone). You’re feeding the baby. That’s rule number one. Rule number two is to maintain your milk supply. That’s where the shield MIGHT work against you, but it might not, and there might be other solutions to that problem if you encounter it on the shield. (Pumping, herbs, teas, Domperidone, etc.)

I’m guessing there are some readers out there who can chime in with some first-hand experiences with nipple shields and how to wean from one and what can happen if you don’t. So I shall pass the microphone to them. Good luck.

Photo source: Milky Way Lactation

Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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