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You have just spent the first 24 hours of motherhood breastfeeding your baby, only to be left with raw, bleeding nipples. Your discharge is coming up in a few hours, and you panic at the thought of continuing this torture at home, so you ask the hospital lactation consultant or nurse for help. She takes a peek at your breast, gasping at how flat your nipples are, and presents you with the panacea: a nipple shield. Placing it around your nipple, she shows you how to latch your baby on and voila. The pain is nearly gone. You go home, relieved at the reprieve.

After a couple of weeks of nursing with the shield, things still don’t seem right. You were prepared for feeding every two hours, but instead she feeds for two hours straight. When you stop nursing, milk still drips out of your breasts. Your nipples, while less damaged, are still raw under the silicone. Curious, you pump your now less engorged breasts, and only get only 1 ounce from both sides combined. What is happening?

Nipple shields, while quite popular on labor and delivery floors, are a mixed blessing.

They mask the problems, but they don’t fix them. Made of silicone (they used to be made of lead, glass, wood, silver, or animal skins) they provide a barrier between your baby’s mouth and your nipple, which makes it hurt less. The problem is, moms need the (pleasant) stimulation of the baby’s mouth on the areola to produce more prolactin receptors to have a bigger overall supply down the road. In other words, a nipple shield can decrease your overall supply.

And while the shield gives your baby something to put his mouth on, it doesn’t change the way he latches. In fact, the shield makes sucking and swallowing more difficult. At first, your breasts may push milk through the shield so your baby gets more with it than without it. But since it does not help him transfer the milk out, you are at risk for mastitis, plugged ducts, and an overall lower supply down the road. Moms who produce a lot of milk, or oversupply, can manage with a shield for some time because their supply is not as dependant on milk removal as other moms. But most moms will notice that this panacea only helps at first, and in the long run makes everything worse.

So what are you to do? A good rule of thumb is that if you need a nipple shield to nurse, it is because something else is wrong. And that something else is almost always your baby’s gape restriction. If your baby cannot gape widely enough and can’t get onto your areola and nipple (no matter what size and shape), then you have to fix that problem first. Later, only when your baby is able to gape and therefore transfer milk, you can use a nipple shield as a barrier to allow your nipples to heal while nursing or get nipple confused babies back onto the breast.

 

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