15/04/2022
Stop Being Anti-Ni**le Shield
I’m perplexed at the number of professionals who are categorically against the use of ni**le shields. I hear things like:
“Ni**le shields don’t work”
“Ni**le shields will confuse the baby”
“Ni**le shields will ruin your milk supply”
Huh?
Let’s review a few studies:
1) Hanna et al (2013) - “A description of breast-feeding outcomes among U.S. mothers using ni**le shields.”This longitudinal study looked at 81 postpartum mothers who used shields. 72% of moms reported that the shields were “extremely helpful”. The authors concluded that shields can help moms who may otherwise abandon breastfeeding. While the study isn’t controlled, it is helpful to see that moms can use the shield and eventually wean off.
2) Kronborg et al (2016) - “Why do mothers use ni**le shields and how does this influence duration of exclusive breastfeeding?” This is a larger study of 4815 Danish mothers who self-reported information regarding ni**le shield use. First time moms were more likely to use shields as were moms of babies with lower gestational age or birthweight. Some moms were helped and others became dependent on its use. There was a 3x increased rate of stopping breastfeeding if the shield was used - this is an important point we’ll discuss below.
3) Meier et al (2000) - “Ni**le Shields for Preterm Infants: Effect on Milk Transfer and Duration of Breastfeeding” - This study looked at 34 preemies and compared feedings with and without the shield. These babies consumed more milk with the shield than without. The authors didn’t find a correlation between ni**le shield use and a shorter duration of breastfeeding.
There are more studies. But I chose these to make a few points. Ni**le shields have the capacity to help. They also have the capacity to contribute to prematurely terminating the breastfeeding relationship. There are definitely instances where they become needed - severe ni**le pain and an inability for the baby to latch on at all are the most prevalent in my experience. There is evidence that shield use can help a mom hang on until she can be supported.
My thoughts:
1) The use of ni**le shields should not be condemned. What *SHOULD* be condemned is the use of a ni**le shield as a permanent solution to breastfeeding symptoms. What *SHOULD* be condemned is the distribution of the ni**le shield to moms immediately in the hospital by a nurse, physician, unit secretary, custodian, friend, family member, etc (this seems to be the case now, where anyone can hand out a shield). The only time a shield should be used is under the guidance of a lactation consultant. More importantly, the use of the shield needs to be followed because I'm convinced that the moms who end nursing early because of shield use don't do it because of the shield, but rather that their breastfeeding is so poor that even the shield doesn't help them. Someone needs to figure out why.
2) The ongoing need to use the ni**le shield means that you need to investigate the oral anatomy of the baby. In my world, the need to use the shield beyond 4-6 weeks indicates a higher likelihood of tongue tie.
3) Just because you have flat ni**le does NOT mean you need a shield. Remember, flat ni**led moms made it through evolution without shields. I would argue that a flat ni**led mom who has a tongue tied baby has a higher chance of needing the shield. If the baby is dependent on using the lips instead of the tongue (a common compensation), then shield use becomes more common because the baby is turning the breast into a straw.
Investigate WHY you need the shield.
Don’t be afraid to use the shield as a crutch. It’s a temporizing measure to get things to settle down.
It’s a tool. It’s not a plan. If you tore your ACL but your surgeon told you to just keep using crutches, you’d balk. This is no different.
