The Ordinary Doula Podcast
Welcome to The Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning. We help folks prepare for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
The Ordinary Doula Podcast
E82: Nipple Shields: Know When to Use this Breastfeeding Tool
Nipple shields can be valuable, often temporary tools that help overcome breastfeeding challenges like flat or inverted nipples, painful feeding, or difficulties with preterm babies. When used appropriately with professional guidance, they can help maintain the breastfeeding relationship while addressing specific issues.
• Nipple shields are thin silicone devices that fit over the nipple with holes for milk flow
• Best used under guidance of a lactation consultant as a temporary solution
• Particularly helpful for flat/inverted nipples, preterm babies, and painful nipples
• Can serve as transition tools from bottle to breast
• Available in sizes from 16-24mm, with 20mm being the standard starting size
• May reduce milk transfer in some cases but can enable breastfeeding that might otherwise be impossible
• Clean after each use and wash thoroughly multiple times daily
• Mark clear shields with permanent marker to prevent losing them
• When weaning off shields, try direct breastfeeding when baby is hungry but not frustrated
• May need to pump after shield feedings to maintain supply
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.
Speaker 2:Hello, welcome to the Ordinary Doula podcast. This is your host, angie Rozier, and today we're going to address a little bit more on the lactation side of things. We're going to address nipple shields. Sometimes nipple shields get a bad rap in the breastfeeding world, sometimes they get overused, sometimes they get underused. But we're going to kind of address that today and talk about good times to use them and when to not use them and how to stop using them. So, nipple shields let's talk about first what a nipple shield is, and it is best to use a nipple shield under the guidance of a lactation consultant, because it's a great tool but it's, yeah, like I said, underused and overused sometimes, or misunderstood. So use it with a little bit of guidance.
Speaker 2:So, first of all, a nipple shield. I want to just define what it is. It's a very thin, flexible silicone device that goes right over right on the breast, goes over the nipple and the areola. There's little holes in the end of it so milk flows right through it. So the baby's still on the breast, but it does have this little silicone barrier. Um, it used to be back in the long ago. There were metal and wooden versions of this in different centuries and now we have a really nice soft, flexible silicone material that is much better than anything they've had in the past. So size and fit does matter. So if you're using one, make sure that the size and fit is good for the baby, the baby's mouth, the mom's n and what it is we are working with there. So some I know that hospital lactation consultants kind of have a reputation for using these quickly, whereas some private consultants may not use them as much. I trained in both private and hospital practice and work in both private and hospital practice and I like the Nipple shield. It's not my first go-to by any means, but in a lot of cases it has a lot of different purposes for use that can be very helpful that nothing else really can touch on. I do generally recommend it to be used very temporarily.
Speaker 2:Very rarely do nipple shields need to be used throughout the entire breastfeeding journey, but it can be a tool in the beginning, kind of like a little crutch, if you will, just kind of a helping hand until things change, like baby's mouths grow and milk supply comes up and nipples create a little more elasticity. Sometimes that nipple shield is exactly what we need. So some very obvious cases you'd want to use a nipple shield is if we have a flat or inverted nipple. The nipple shield is simply an extension of the nipple right and it's a soft little extension that the baby can feel in the back of its mouth a whole lot more easily than it can a flat or inverted nipple and nipples come in all shapes and sizes right. Some people don't ever need to use a shield and other people will need to rely pretty heavily on one. So for babies to get the reflex to suck and keep sucking, the very back of their palate has to be touched. Now breasts and nipples can be sucked back to that spot, but it takes a few sucks and it's not like we can explain to a baby like, hey, just suck for 30 seconds and you've got it. And some tiny little mouths don't have the capacity or the strength yet as they're learning to pull.
Speaker 2:A challenging nipple might be flat or inverted all the way back. So in those cases we do lean on pretty heavily and are grateful for the tool of a nipple shield. I would say truly inverted nipples, which are pretty rare. Actually, that's the most important and the longest term use of a nipple shield is with truly inverted nipples, flat nipples can be pulled out. Inverted nipples can be worked with, sometimes too, again depending on the size, shape, strength of the baby's mouth too. Sometimes we have a preterm baby or a low tone baby whose suck is kind of weak and they need a little bit extra firmness, if you will like something to grab onto while they're learning, growing and developing. We may have a lip or tongue tie that inhibits the baby's tongue from being long and doing a good long pull. So, having a longer nipple, we can accommodate a shorter tongue or a tighter tongue. If people choose not to get a tongue revision or whatever, then sometimes that nipple shield makes breastfeeding with a tongue tie possible in those cases.
Speaker 2:Sometimes nipple shields are used because the nipples are trashed. They might be cracked, bleeding, very painful, and it can be a friction barrier that little silicone can go over. The baby can still latch, be at the breast and feed while those nipples are healing, rather than have the continued friction from the baby's mouth. And then sometimes nipple shields another great tool for them is a transition tool. So maybe we have a baby who has had a whole lot of bottles for whatever reason. They've been in the NICU.
Speaker 2:We started out with bottles, whatever that might be that babies kind of get used to again. They need that back of their mouth, stimulated, their soft palate, to keep them sucking and bottles travel straight back there. Right Pacifiers go straight back to that spot and keep it stimulated. Fingers if the baby's sucking on mom's or dad's finger, that goes straight back to the spot. But the breast again needs to be sucked a little bit back there and babies are kind of unreasonable people. We can't tell them, just suck a few times, that'll get better. So if we're wanting them to come off a bottle and go back to the breast a little more, that might be an in-between tool. So it's kind of a compromise between a bottle and purely on the breast so that nipple shield can go back, stimulate that suck reflex on the back of their soft palate and then as baby grows and gets stronger we can kind of come off of that so that the baby can take the breast itself and the nipple back there.
Speaker 2:So nipple shields do have some benefits. They assist with latch and suction when babies are struggling. They can protect sore nipples so the mom can continue to breastfeed rather than to stop or or um pause her breastfeeding. They can allow breastfeeding to continue instead of switching to bottle or formula if we're in danger of that happening, say with a tongue tie or something, um, and they can be really great for NICU or preemie in that context to promote milk transfer and have the baby eating at the breast even if it's not totally eating at the breast. A nipple shield a lot of times we'll use them to if we're using an SNS or a supplemental nursing system. Maybe we have pumped colostrum or milk that we're putting through this tiny tube where we have formula and that nipple shield can be kind of a stabilizer for that little tube, whether we put it in the front or the back of that. That can help. So baby's still at the breast but they're having a little bit of extra help from a couple of contractions and sorry contraptions and we're getting breast stimulation. At the same time the baby's being fed. So a lot of times this is waiting for the milk to come in, of course.
Speaker 2:So some drawbacks to using um nipple shields it can reduce milk transfer some kind sometimes and reduce supply. So baby might not get as much milk um, sometimes they get more if they're not getting any at all, but they might not get as much with a nipple shield as they are, as they might with just on the breast. Um, sometimes it is more painful for the mom to use a nipple shield Not always for sure. I'd say. The vast majority of the time the nipple shield's more comfortable, especially with a sore nipple. But sometimes it's more painful to use that shield. Sometimes it gives babies a little crutch some like latch dependency. They become reliant on that shield and they may not want to breastfeed, and we'll talk in a moment how to wean off of a breast or a nipple shield. It does reduce skin to skin contact, right. So some nipple shields, depending on the brand, have a little notch cut out for the nose so the baby can still smell. You know the Montgomery glands and what they're doing but it does reduce some skin to skin contact right in the baby's mouth and can inhibit some hormone feedback loops. However, we can have a lot of other skin-to-skin going on with the rest of the mom's breast body and the baby's body as well.
Speaker 2:This is something to clean, right. It's something to keep track of, something that needs cleaning. So we want to make sure it's cleaned properly, rinsed very frequently, cleaned with soap and water a couple times a day, depending on how often you're using it. A lot of these nipple shields are clear silicone. They get lost in bed sheets really easily. If you're washing them in soapy water they disappear. So I often suggest to my clients to put a line of Sharpie like a permanent marker on the edge of that so that you can kind of see it. It's easier to keep track of that way.
Speaker 2:Some people are worried about weaning off of the nipple shield. That might be a hesitancy to use that shield, but I have seen in many cases where it makes all the difference and we can continue breastfeeding. So with nipple shields, again I love them. Well, I love them temporarily. So I like them to always be a temporary tool. And when you go to use a nipple shield and hopefully you're working with someone to help you have a weaning plan from the get-go. Like be ready to not use this tool sometime.
Speaker 2:Um, sometimes, right after breastfeeding with a shield, we might want to pump a little bit just to maintain that supply, because the baby might again, you know, it's just kind of a barrier between mom and baby and might not stimulate the breast as well and then try it without. Just as you try to look at weaning, sometimes you can use the motivation of being hangry for that baby to latch just latch on to the back for a deep latch, for efficient milk removal, for minimum, you know, discomfort for anyone, for mom or baby. And clean shields like rinse them after each use, wash them a few times a day, depending on how long you're using them. Some people will have a couple of them around the house, wherever it is. They kind of have their little breastfeeding stations. So, just to wrap it up, shields can be a helpful tool, sometimes a vital tool, especially in early or challenging situations, right, depending on what we've going on. But make sure you kind of monitor the use of that, seek professional guidance, as you're just considering, like you know, work with an IBCLC, as you're considering a shield or kind of winning off a shield.
Speaker 2:So the nipple shields come in sizes between 16 millimeters to 24 millimeters. The hospitals I work at have and I think it's pretty standard 16, 20, and 24 millimeters. We always start with 20. Like, we'll just kind of start with a 20 millimeter, unless we have a really tiny baby. Say we have a five pounder, a baby in the NICU or something we'll do. The 16. Very rarely are we'll do. The 16, very rarely are we going to do the 24 millimeter one?
Speaker 2:Um, if we have a pretty large you know lga, pretty large baby or very large nipples, again, nipples come in sizes between like 10 and 30 millimeters. Um, but with the nipple shield or that that just covers the nipple, we're not as um, we don't have to be. The nipple shield that just covers the nipple were not, as we don't have to be as accurate as we would say with a flange fitting. But I have worked with, I've worked with a mom who had very large nipples they were some of the largest that you'll see with 30 millimeters across, which is about an inch, and she had a four pound baby. So that was tricky and we did a lot of pumping when we were able to. We had to use the nipple shield for a little while for that baby to kind of learn to breastfeed.
Speaker 2:So, again, a temporary tool, but realize that it is a tool Rather than ending a breastfeeding journey. Hopefully you can use tools to continue it and to get it to a spot where you want it to be. You can use tools to continue it and to get it to a spot where you want it to be. So thanks so much for being with us here today. Hopefully this may have answered some questions that you've had or given you some thoughts or ideas on how to improve or enhance your breastfeeding journey. Nipple shield could be a great tool. Usually, it's a very temporary tool. Hope you keep that in mind as you go about your breastfeeding journey. We wish the very best for you and if there's anything we can do to help, please feel free to reach out. You can find us at birthlearningcom and we'd love to help you on your pregnancy or breastfeeding journey. This is Angie Rozier, with Ordinary Doula Podcast signing off and, as always, go out and make a great human connection today. See you next time.
Speaker 1:Thank you for listening to the Ordinary Doula podcast with Angie Rosier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth. Thank you.