nipple shields- long term use

[whimsicalquark]

My DD is 3 weeks old.I had a difficult start with breastfeeding, she would not latch on no matter what I tried. I was told I had flat nipples and dont think it helped that my baby was very battered due to forceps delivery.
I ended up hand expressing at the hospital but couldnt seem to manage this very well at home by mysef at home so for the first day n half at home after much stress and tears she had pump expressed breastmilk topped up with formula. Then the midwife suggested nipple shields, these were a godsend and we then got a good latch,she now feeds using these beautifully and is fast gaining weight (8.15 born and now 10 pounds at 3 weeks) the issue is everyone seems very ngative about the shields, the midwife , HV and feeding support worker not to mention family keep hassling me about weaning her off them, no one really explains why I need too. Im very reluctant to go through the stress and tears again as last time i was ready to give up on bf. I do try every so often to get her to latch on without them but no success. Is it really that bad to continue to use them ? ppl have mentioned nipple confusion but this wont be a problem as she already feeds from bottle with expressed bm and uses dummy so another bit plastic shouldnt make any difference. I also dont like breastfeeding in public so will I give her expressed BM when we go out.
Has anyone continue to use these for duration of bf ?sorry for long post

I and three others I know all thought we would be using shields for the long run, but all our babies, at around 16 weeks, just knocked them off and latched on - it me a while to figure it out!

It's something to do with development and the mouth growing etc.

I was getting sick of them because they do make feeds longer - as its harder for the babies to suck the milk than without shileds. I was amazed how quick feeds became once I got rid of them.

I have no idea what nipple confusion is - DD started off with being fed by syringe, then bottle of EBM, then latch with shields and now finally just on the breast, all with no problems.

Oh gawd. If they are working for you and your baby, just ignore everyone else. Jeez-it's annoying, isn't it, the constant interfering and hassle. Makes me want to scream!

If they help with bf, then stick with them. I think they are brilliant, although I agree with MotherPanda about it taking longer. Do what you feel is best for you, trust your instinct.

Thank you both for replies. thats great to know that she may just latch on herself without me needing to do anything. im hoping the shield may somehow stretch my nipple so that its no longer flat if thats possible !

yep civilfawlty it makes me want to scream too the constant 'advice' (read interferance) seems to start as soon as you announce your pregnant, are you eating this and this, hope your not thinking of calling your baby that, what are you going to do with that cat and seems to get a million times worse when the baby arrives, argh it winds me up

Hi, I had this exact same thing with my ds. The hospital really shouldn't have let you go home without being sure you could latch baby on but that's a desperate rant on my part!

We used shields for a while but the best thing I did was have a community nursery nurse come out to my house and latch baby on with me. It took her 15 minutes and he fed straight from me from then on. I had spent all time since birth with no idea how to get him to latch. ( I was told at hospital I had flat, large nipples and ds was tongue tied and had small mouth so it would never work! )Have since found none of this to be true! He was nearly 5 weeks at this point and I though would never learn how to latch.

He also took bottles and dummy without problems. Nipple confusion seems a lot of rubbish to me!

The negativity surrounding long term nipple shield use is due to the chance of supply dropping.

As the nipple isn't getting direct stimulation so the hormones released during feeding with a shield isn't the same as direct bfing so when milk supply goes from hormone driven (placenta being removed starts this off) to being supply and demand some women find they no longer make enough milk.

Some babies also get less volumes of milk with a shield as baby is using suction (and the mother's let down) to get the milk rather than compressing the breast tissue with their tongue which gets higher milk yields.

This isn't a cast iron guarantee that this will happen to you but that it is a distinct possibility that those who advised you to start using the shields should have informed you of.

Nipple shields also inhibit some of the immune factors in the bm as baby's saliva coming in contact with the nipples trigger the body to release anti-bodies into the milk to any germs in the saliva.

If stopping bfing in the near future is something you are thinking of then continued use of the shields isn't going to be a problem but if you want to bf for the medium to long term then it might be worthwhile seeing a breastfeeding counsellor or IBCLC to work though dropping the shields.

My DS is 21 weeks and only learnt to latch on without shields 2 weeks ago. I had flat nipples and he had a high palate so found it very difficult. I just kept trying without every now and again. Good luck!

I could have written that post myself. Ds is 11 weeks now and we're still using them. I do keep trying without but its so hard, he wont stay on, and I just want to make sure he's getting fed so keep putting them back on. Each feed takes an hour at least but I dont want to give up :-( Encouraging to read that he might suddenly start latching on. I really hope that happens for us, feel sad that I might not be able to bf long term otherwise.

Anyone still struggling I really advise contacting the breastfeeding support groups in your area. They are so helpful and huge amounts of latch on problems are positional. They are so supportive deffo recommend them!

I have been breastfeeding with nipple shields for almost 9 months! I am only just starting to wean onto formula feeds now that he has started dropping feeds with his increase in solids.

I was in a similar situation to you: I have flat nipples and my baby was 5 weeks early so found it difficult to latch on. Not being able to breastfeed him (and really wanting to) was the only thing stopping him was coming off the drip and being able to come onto the postnatal ward with me so a nurse suggested shields and we never looked back.

I tried weaning him off them at various points but he just wasn't having it. He is very happy and healthy and has consistently grown in line with the charts. I had some pressure from HV/midwives but having been open about it with friends, have found a lot more people have successfully used them than you would ever think.

Do what is right for you and your baby. The things being said about reducing flow etc is linked (I believe) to the old style shields which weren't the thin silicone that they are now and were a thick rubber. I have never had any problems with supply/flow.

Of course I would have loved to have been able to feed him without the shields but almost 9 months in I'm a pro at getting him latched on discreetly in public (it didn't take me this long, it took a matter of weeks to learn to be discreet - a wide cotton scarf will be your best friend) and his feeds, though admittedly long for about 5 months, became much shorter and more manageable until now where they are around 10 minutes maximum.

Sorry this is so long but it is a subject very close to my heart and it makes me really cross when mums are made to feel guilty about using shields when often it's the only way to get a baby to have breast milk directly from the mum.

Hi MargeryDaw, thanks so much for sharing, thats really encouraging to read :) I'm definitely struggling with the idea of bfing in public cos it is that little bit harder to be discreet with the added hassle of getting the shield in place and I do feel a bit embarrassed using them.

Please dont worry. I was in the same boat - baby wouldn't latch on without them at all. I also felt I was "in the wrong" for using them but it worked well and my supply was always great using them. Just kept trying without and baby learned to latch on herself with no problems at about 3-4 weeks old

What Truthsweet says summarises the risks of them really well. They are generally best only used under the guidance of a lactation consultant or breastfeeding counsellor because of these risks. Also as you say, feeding in public with them is a hassle.

It's brilliant that they've worked for you, and they can be exceptionally helpful in many cases, but they are for very good reasons designed as a short term help.

Between not breastfeeding and not using NS, and BFing and using NS, using them is absolutely far and away the best option! But if you can transition to not using them then it is likely to a) make BFing easier (once transitioned - obviously at the moment they're making it possible but you know what I mean!), b) ensure that they don't interfere with supply, c) ensure that your body is getting all the messages it needs to make the antibodies for your baby.

So there are good reasons why people are saying that it would be worth trying to wean off them - it's not just people trying to be difficult :) But you are likely to need some proper, qualified support.

I'm really grateful for these posts as my DD is just under 2 weeks old and I'm already eaten up with guilt over using nipple shields rather than feeding her naturally.

I know it's really early days but last week I was in such pain every time she tried to feed that I was in tears and ready to give up, it was only a visit from a community mw who gave me the shields that kept me going.

Every expert I've seen says she's latching on correctly but it feels as though she's mashing my nipple between her (very hard) gums, with the nipple shields however there's no pain, latching on is effortless and she seems able to feed for longer.

My concern though is that whereas everyone seems to say that the ns make the feedings longer my DD only feeds for 10 mins ever 3 hours -she has been gaining weight but I'm not convinced she's getting enough. Unfortunately she falls to sleep at every feed and nothing will convince her to continue - not changing positions/ skin-to-skin/ tapping feet. The mw's say she's fine and I shouldn't worry but I'm trying to get her to take extra feeds by expressing so that I know she's getting at least one good meal a day at least.

Am I right to worry and does anyone have any suggestions for what to do to improve the situation? Apologies for the long post but am wittling myself silly!

Bexworth - Had baby been checked for Tongue Tie (and by that I mean by a trained in TT evaluation HCP not someone going 'that look's fine to me' and not assessing properly)?

When baby does feed directly what happens to your nipple? Does it change shape (lipstick/bullet/wedged), have a ridge running around it, change colour (whitens/purple) or just look nipple shaped (perhaps a bit longer)?

Babies do fall asleep when feeding - it's nature's way to ensure mum gets to sleep too - the only worry is if they latch on then fall asleep with in a few seconds not if they feed for 5 minutes then doze then wake and feed for a bit then doze and feed for a bit....

Have you tried Biological Nurturing rather than latching baby on yourself?

What was the birth like (assisted delivery/premature/c-section/NCB)? Was bbay 'helped' to bf by someone putting their hand on the back of her head rather than her neck?

Actually, recent research suggests that shields don't affect supply as much as previously thought - see here

I quote...

Since writing the post, a follow-up study has been published, this time looking at the relationship between shield use and infant weight gain over a much longer period2. 54 mothers who used a nipple shield provided by a nurse or lactation consultant in the period just after the birth of their babies were recruited for the study, and completed interviews when their babies were 2 weeks, 1 month and 2 months old. Over time, the proportion of mothers using shields diminished (at 2 weeks, 69% of the mothers were still doing it, at 1 month 48%, and at 2 months 33%) and at each stage the responses of women who were still using the shields were compared with those who weren?t.

The main aim of the study was to determine whether nipple shields had a negative impact on weight gain ? if babies whose mothers were still using shields grew more slowly than those whose mothers had stopped, then this could be taken as an indication that medium to long term use of shields was causing a real problem. Happily, there was no difference between the groups: whether a mother used a shield made no difference to her baby?s pattern of weight gain.

There were a few complaints about nipple shields: 8 women thought they caused nipple soreness; 2 found them messy; 2 found them inconvenient and 3 had problems with them falling off. In spite of this, 90% of the mothers in the study said that using the shield was a positive experience, and 67% felt it helped prevent them from giving up breastfeeding.

If you are a mother who relies on a nipple shield to breastfeed, these results make reassuring reading.

Not a completely persuasive study, but interesting. Supposedly the previous studies used the older, harder type of shields, which weren't so effective.

It makes sense, really - if women can pump for months, and not lose their supply, one would think that sucking through a shield is a better approximation to ordinary sucking and not so much of a problem either?

Hi Truthsweet - no she's not been examined for TT - the mw's etc all seem more bothered about me being the problem than looking at her, even though they all go on to say that I'm doing everything right when they observe me feed her. She latches on well but then moves her mouth resulting in a really shallow latch.

When I was directly bfing my nipple came out looking flat and squashed, looking at it top down it looked oval with a ridge down both sides and often went white.

The birth was a difficult one - 29 hours in total, had originally intended a water birth with just gas but due to complications it ended up being a ventouse birth with diamorphine (which I really didn't want to have to have).

When feeding directly she was only on for a few seconds each time before falling asleep - it was such a short amount of time that when I was quite chuffed that I managed to keep her on for 2 mins on the 2nd day the mw pretty much laughed in my face before telling me she should be on for at least 30 mins. :(

She seems happy enough with what she takes and wakes like clockwork to feed every 3 hours, I do look out for signs though in between and do feed her if she seems to require it but she doesn't often - usually sleeps right through until 3 hrs are up but I'm still worried.

I should also say that before starting to use ns DD had lost 9.9% of her birth weight at her first home weighing - since then she's not only put all her birth weight back on (admittedly with a bit of v. painful direct feeding) but using just the shields and expressing put on 2 & a half oz in 2 days.

I'm hoping I'll be able to eventually feed her directly but I have managed to feed her in public with the shields and no longer feel afraid of each feed - surely me cringing away from her everytime she tries to latch on isn't good for our relationship and reduces any mum/baby benefits of bf?

Bex - That does sound like you've had it tough! Well done on getting through it (I know you are still in the thick of it but you have really well to get through the 1st 2 weeks) Have you got a BFC or specialist MW providing you with support at home?

Have you heard of exaggerated latch aka the 'flipple'? It's a way of getting baby latched on deeper and can be quite helpful with babies who are shallow latchers.

It might be worthwhile asking for an assessment at your local TT Clinic (ring up the Post-natal ward and ask or get your HV/MW to refer). If there isn't a TT Clinic locally you can ask to be referred to the regional one or try a private referral or contact an IBCLC who does TT divisions.

This article has a lot of information on signs of TT.

Is baby doing 6 heavy wet disposable nappies (or 8 wet cloth nappies) and 2 yellow poos a day?

I used them with both my dds purely because neither of mine would latch without. I constantly tried to wean them from them just because I personally thought they were a nuisance. I wanted to be out and about and be able to nurse discreetly without having to try and position a shield.

Also, when I used them my nipples used to get sucked right to the tip of the shield and my nipples would go through the holes in the end and get damaged. I would literally need to be scraped from the ceiling with the pain

Looking at the positives.. If it wasn't for the shields I would not have been able to experience feeding my girls from the breast. So I was delighted that they were an option and saved bfing for us.

Take a step back from your situation, ignore all the negatives and listen to the positives only.

If it works for you and your baby that's all that matters x

Truthsweet - Thanks for the links I'll have a look at them.

As for the nappies we're using reusables and we're getting 6 v. wet and 2 huge yellow/ orange dirty ones a day so I think she's doing ok I would just feel better if she was on for longer.

This could be me too..
Wanted home birth but labour didn't progress and after 18 h labour had baby by forceps and spinal block. Couldnt cuddle baby straight off as immobile. :-(

First few days were bad, baby didn't latch or feed properly, however with support from NCT and family got expressing and feeding the results enough for mw to let her stay at home.

Have now at 6 days progressed to feeding on nipple shield and expressing to top up. Latching is tricky enough with the shield, trying without results in no latch at all.

It seems that my large boobs and flat nipples are the problem, otherwise baby is big and healthy and I make way more than enough for her.

Without nipple shields i could no bf at all!

Good news - the midwife's been today and weighed baby and she's gained 4oz in 4 days so she's obviously getting some milk!

hi everyone

After going through a 4 day long labour and forceps delivery, our wee one was not incredibly interested in either feeding or latching, making each feed an ordeal...one incredibly insensitive mid wife even suggested that I should grin and bear it as my "pain threshold appears to be quite low"!!!!!!!! This came from a 25 year old who hasnt had any children yet!!!

He seems to fall asleep on the breast rather than suck and he won't latch properly, resulting in incredibly painful feeds... my nipples seemed large enough and the milk came rather quickly and in good bulk so I don't know what the prob is...
Our bub is only 8 days old so I want to ensure he is feeding regularly and well.
After much pain and stress, I decided to use the shield today as I couldnt bear another day of bf agony....

Some mums commented that "feeds take longer".... mine last approximately 25' in total each time... is that too long or too little? Made no difference if the shield was on.

Help?

Hi annaif

I too experienced a 4 day labour and forceps delivery - not a lot of fun eh?!

We used shields for the first 13 weeks and feeds just kept getting longer until it was taking over an hour. I think 30-40 mins was quite normal for us in the beginning. I think the increase in length of feed was probably because it was affecting my supply and ds was finding it harder to get milk. He also started dropping centiles.

Suddenly at 13 weeks DS decided he was going to knock the shield out of the way and start feeding without it. I honestly did not believe this would ever happen - you can see this if you read my posts on this thread from earlier in the month.

In the 2 weeks since we stopped using the shields DS gained 1lb and 7oz! Basically I am just very proud that I stuck at even though it was stressful worrying DS wasnt getting enough and sometimes it felt like I was feeding constantly but it was all worth it. Its so easy now, feeds take about 10-15 mins and I've even been bfing in public!

So stick at it and like others have said try a support group cos I think I'd have got DS to latch on a lot sooner if I'd got some RL support.