Nipple shields are a commonly used tool in the lactation world. They may help a premature baby latch to give the baby time to mature and learn how to suck, prevent nipple damage from a tied baby, or be used when a nipple is flat/inverted (either from normal anatomical variations or because the breast is fluid overloaded from interventions during birth).While there are many benefits to using a shield, are also risks, like the potential for decreased milk supply. Hopefully if you were given a shield, you were also given an exit strategy for weaning off of it. With any tool, make sure the reason you were given one has been addressed (giving a premature baby time to grow, doing oral motor exercises and a tie release, education that fluids during labor and delivery can temporarily make breast tissue swell and make nipples look shorter or flatter than they naturally are, etc). When you are ready to wean from one there are multiple strategies to help:
Start with the shield on and take it off after the first let down once baby is not as hungry/use it on the first side and not on the second side
Try without the shield once a day during daylight hours when baby is happy and not too hungry. Catching early hunger cues is imperative. If they’re crying, try a different time
Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible
Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch
Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible
Hand express to get milk flowing to keep baby interested
Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby
Try a different shield like the Lovi or Dr Brown’s which are thinner and give you more stimulation
Did you use a nipple shield to help your baby latch? Want to transition baby off the shield? First, weaning from the shield is your choice. If you like it and it’s comfortable for you, don’t feel pressured to get rid of it before you and your baby are ready. There are risks associated with shield use, like the potential for decreased milk supply. But if that’s the only way your baby will latch right now, give yourselves time and grace to keep trying as baby gets older and more proficient at the breast. As always, if you’re really struggling to get off the shield, find a knowledgeable lactation consultant to help you with the process to make sure something else isn’t going on with baby’s latch.
💡You can always start with the shield on and take it off after your first let down once baby is not as hungry or use it on the first side and offer the second side without it
💡Start by trying without the shield once a day during daylight hours when baby is happy and not too hungry. Catching baby with early hunger cues is imperative. If they’re crying and really hungry, try a different time
💡Start in skin to skin. Taking a bath together can help. Try to be as relaxed as possible
💡Try to erect and evert your nipple. Use reverse pressure softening (RPS, see highlight reel), a pump or stimulate your nipples with your hands before attempting to latch
💡Help baby latch with laid back nursing, supporting the breast in a “C” or sandwich hold, or the flipple. Make sure baby’s chin and cheeks are physically touching the breast as much as possible. A baby that can’t feel the breast can’t latch to the breast.
💡Hand express to get your milk flowing so baby gets instant satisfaction and reduce the work
💡Relax and be patient. Babies can feel your energy. The more you can see it as fun practice, the less pressure you’ll put on yourself and your baby
💡Try a nipple shield weaning system like this one from Back to Mom (24mm) or Lacteck (small/20mm).
It’s normal to experience nipple tenderness for the first few days after delivery. Tenderness peaks between the 3-6th days postpartum and then should resolves by the end of the second week. Any damage to the skin of the breast or nipple should be taken care of immediately to avoid further damage or infection.
Painful breastfeeding is not normal. The first step to decreasing pain while breastfeeding is to identify what’s causing it. Usually the simplest way to reduce nipple pain is to make sure baby is in the right position. Baby’s tummy should be touching mom’s body, with the belly button touching. Baby’s arms hug the breast and their face comes straight to the nipple. Baby’s Head should be straight, with their ear, shoulder and hip making a straight line. Their head should be slightly extended backward to allow the nose to pop up off the breast. Pulling baby in closer through the shoulders usually helps get a deeper latch. If nursing is still painful, even with careful attention to latch and positioning, there may be other things at play. Usually there is a tongue/lip tie, tension in baby’s body like from a long labor and delivery (greater than 24 hour labor and/or more than 4 hours of pushing), or tension on baby’s body from intrauterine position (sitting really low for a large portion of pregnancy or being breech). Having the tongue tie released and/or doing tummy time and bodywork on baby should resolve the pain. If you’re working on release and baby’s body, consider the temporary use of a nipple shield to protect nipples, until damage is resolved and the underlying cause of the damage is managed.
When your nipples are already damaged:
Step one: Wash and Rinse Damaged nipples are prone to bacterial infection. Washing and rinsing damaged nipples can help prevent this type of infection. When bacteria grows in a wound, they create a bio-film that lengthens healing time. Baby’s saliva also fosters this bio-film. Washing cracked or fissured nipples gently twice a day with a gentle, fragrance free soap (not an antibacterial soap) and rinsing them with water can help remove the bacterial bio-film and allow faster nipple healing. Stop washing with soap once the nipples are healed. After every feed, rinse nipples with either clean water or a saline rinse. You can make your own saline rinse by mixing ¼ rounded teaspoon of sea salt with 8 ounces of warm water. Soak your nipples in this solution for 30-60 seconds. Soaking for longer may actually over hydrate your skin and increase cracking.
Step Two: Moist Wound Healing after washing and rinsing and/or soaking your nipples, dry and apply your antimicrobial ointment of choice. This could be virgin coconut oil, Dr Jack Newman’s All Purpose Nipple Ointment, or medihoney. There are other nipple balms and butters on the market. Make sure the one you’re using is antimicrobial. While you may think airing the nipple out will help scab the nipple over, Keeping cracks covered with some type of ointment promotes moist wound healing which is better for the sensitive nipple tissue which is a different kind of tissue than the rest of your skin. A non-stick wound pad, reusable breast pad, or a cooling breastfeeding gel may be placed over the ointment to keep your nipples from sticking to your bra or clothing. Ointment should be applied like chapstick, in a thin layer. Gently wipe off any leftover ointment before baby feeds. Disposable nursing pads should be avoided as these do not allow for good air flow and the quick wicking material tends to stick to nipples. Wool breast pads are preferable for their antibacterial and air flow properties.
Monitor for Infection Contact your primary caregiver physician and an IBCLC lactation consultant if you have any signs of infection like increasing redness, fever, or pus. If you have a fever of 100 degrees or greater for 24 hours, or bacterial infection which will require oral antibiotics. Research suggests that taking probiotics containing lactobacillus fermentum and lactobacillus salivarius can also help treat bacterial infections of the breast.
Not all nipple shields are created equal. Nipple shields are a great tool that can be used to help baby latch and stay latched, help you heal from nipple damage or trauma, or transition baby back to breast from using a bottle. Nipple shields are a great tool and can be used as long as needed. There are risks to long term use, the biggest one is a decrease in milk supply if baby isn’t able to trigger let downs or remove milk efficiently. If you weren’t given a plan for transitioning off the shield, a qualified lactation consultant can help!