It’s day two in the hospital, your breasts are ready to burst. They feel filled to the brim, but you are still making colostrum. Your nurse is trying to help you get your baby to latch on but your breasts are so full your nipples have almost disappeared. The nurse tells you that you have flat nipples and she runs and gets a nipple shield. The shield works great, now that the baby has something to latch on to, the crying has stopped, and the baby is able to eat. Finally you can breathe a sigh of relief. You are now a breastfeeding momma, and best of all you can go home knowing that your baby won’t starve.
The day after you get home your milk comes in. Your milk is flowing fast and furious; you can see it filling up the little plastic shield every time your baby pauses. Your breasts are beginning to get smaller. Your nipples emerge from the edema and can finally be seen again. They don’t look flat to you, but what do you know. You have already accepted the news that your nipples are flat, so in comparison to other mother’s nipples they must be very flat or else the nurse wouldn’t have said anything.
A week goes by, your beautiful baby is eating so well, but this nipple shield is getting to be a bit of a pain. You have to keep it nearby; it has to be washed constantly. You remember thinking that one of the great things about breastfeeding is that you don’t have to wash bottles all the time. Now you are constantly cleaning this silly nipple shield. Bravely you decide to try and nurse your baby without the shield. But your poor little angel looks confused. Your soft nipple just doesn’t feel right to him. Where is that hard feeling that he has come to associate with your milk? Frustrated he pulls away. You pull him closer but he won’t have anything to do with it. Then the crying begins and you feel like you are right back where you started from.
Unhappily you resign yourself to having to use the shield, but it is so annoying. Going out in public is the worst. Not only do you have to get it out, and put it on (which takes two hands), whenever the baby finishes eating there is always a little milk left in the shield and try as you might it drips all over you as you remove the shield from your nipple. So much for being able to discreetly breastfeed at the mall! In fact using the nipple shield makes you feel so exposed and vulnerable that you decide you will only feed your baby bottles of pumped milk when you go out. Of course this means you can’t go out for very long before you start to feel full and need to either pump or go home and feed the baby. Other mothers have it so easy. You don’t want to complain, but you wish had been blessed with normal sized nipples. Life would be so much easier.
This is an unfortunate scenario, but it happens a lot more often than you might think. Mothers are often told they have flat nipples when in reality their breasts have become so swollen that their poor little nipples have almost disappeared. Breasts swell up for two reasons. Naturally they get swollen because of all the milk they are now making, but also they swell up because of all the excess fluid in a mother’s body. Ankles get swollen, wrists get swollen, the face gets swollen, etc and so do the breasts. All that fluid from the IV in your arm has to go some where! A sunken nipple can usually be drawn out with a little teasing. Luckily, happy babies (as opposed to babies who aren’t offered the breast until they are screaming with hunger) are even better experts at getting a nipple to emerge than their mothers are!
Nipple shields are also used when a mother is experiencing pain in her nipples. Nipple pain happens when a baby doesn’t latch on deeply enough. Mothers are always amazed at how much less pain they feel when a baby is latching correctly. It’s like the difference between getting your thumbnail caught in a door and sucking peacefully on your thumb. One makes you cry out and the other relaxes you. And think about it, after you pinched your thumb in a door what do you do? You put it in your mouth and suck on it! Mothers fear that having their baby suck on a damaged nipple will hurt (which it will if the baby isn’t latching on correctly). But a nipple shield will not change the way a baby latches on. Only time spent improving the latch will do that.
Nipple shields are often used with sleepy babies as well. Sometimes a newborn is very sleepy and it is hard to get him interested in the breast. He could be sleepy because of a very long labor (long labors are tiring for babies too!), or because some of the drugs he was exposed to during labor are still in his system, or maybe it was because he was born a little bit early and he just doesn’t have very much stamina yet. The hardness of the shield and fact that it can hold a few drops of milk often gets the baby interested in the process of feeding. But as we saw above, it doesn’t get the baby interested in the mother’s breast. And once the baby has safely passed the sleepy phase the same problem remains. His brain has already become hard wired to connect the shield with a full belly. A naked nipple just confuses him.
Worst of all, the mother using a nipple shield often thinks the problem lies with her. She thinks her body is defective. Women already have enough body issues to deal with, we already worry about the size of our thighs, our butts and our bellies; do we really need to make women feel insecure about the size of their nipples as well? So now we have a mother who feels her body is inadequate, and who feels that she can never be a normal mother. Does she feel empowered by breastfeeding? I don’t think so.
Does this mean we should never use nipple shields? No, although I would spend a lot more time trying old fashioned skin to skin time before I would reach for a shield. My biggest issue with nipple shields is the lack of follow up. Sending a mother home from the hospital with a nipple shield and no follow up is just wrong, especially if a shield is being used to correct a temporary situation like engorgement, sore nipples, or a sleepy newborn. Unless someone is willing to track her progress in weaning from the shield it really shouldn’t be used.
In my opinion the process of how to wean from a nipple shield should be started the very first time it is introduced. The original goal to breastfeed as opposed to feeding through an artificial nipple should not be forgotten. Mothers should be told to think of the shield as a tool to get them to the next level. It can take a lot of work to reach that goal, and that is where we let mothers down. We get so caught up in the more immediate goal (feed the baby) that we forget the long term goal (to breastfeed the baby). If the goal is to merely feed the newborn the mother can express her milk and give it to her baby with a dropper, spoon, or cup. If the goal is to breastfeed then the baby needs to spend more time at the mother’s breast. Mothers should be encouraged to get their babies used to the breast without the shield from the very beginning. Learning to enjoy holding her baby skin to skin upon her breast without the pressure of having to feed is the first step towards weaning from a shield. But it takes time.
Time however is a luxury you don’t find in most hospitals. There isn’t enough time to try “skin to skin” (and just so you know a mere half hour isn’t nearly long enough), there isn’t enough time to teach hand expression, there isn’t enough time to cup feed a baby, and there certainly isn’t enough time to call a mother at home and see if she is making any progress weaning from a shield. What we are really saying is that there isn’t enough time to give mothers the support they need to learn to breastfeed (as opposed to feeding through a plastic shield). Instead we only take them part of the way there and then leave them dangling on their own, feeling like either they or their baby is defective. We don’t give mothers the time they need in the very beginning to get off to a good start. Is it any wonder that three or even five months later the mother with perfectly normal nipples is thinking about weaning to formula just so she can go to the mall?