How can I get my baby to nurse without using a nipple shield?
I have larger than average
nipples and my baby girl is tiny. She is just now approaching
five pounds. When she was in the NICU they started her on formula
and now she is very confused when I try to offer her my bare breast.
Any advice would be appreciated. I feel like a slave to
I can appreciate your frustration at still
being dependent on the shield. However, if your baby was premature,
then the judicious use of a shield can be an invaluable asset in helping
to maximize milk intake and keep her at the breast until she grows and
matures and is able to feed like a healthy, full-term infant. I don’t
know how early she was or how old she is now, or how long your have
been nursing her with the shield, but those are all factors that must
be taken into consideration when weaning her off .Although there are
no hard and fast rules, many premature or SGA babies don’t nurse effectively
until they reach their full-term corrected age, or until they weigh
about six pounds.
I don’t know how much you know about the history
of nipple shields, but it’s kind of interesting, and may help you understand
a little more about the pros and cons of using the shields in your particular
Shields have been around in one form or
another since the middle of the 16th century. They were used when a
mother’s nipples were sore, and also when the nipples were large/flat/inverted,
in order to make it easier for the baby to latch on. In the 1950′s,
shields were used rather indiscriminately by by hospital nurses who
didn’t know much about breastfeeding. They handed them out to just about
every mother, because it was easier to do that than it was to spend
time assisting the mother with appropriate latch on and positioning
techniques, which would have prevented many of the cases of soreness
that the shields were supposed to help with. There were several problems
with this system: one was that the shields at that time were made of
thick latex (the rubbery amber stuff) and sometimes were attached to
a glass base. Some nurses even handed out regular bottle nipples and
instructed mothers to put them over their nipple when they breastfed.
Because the shields were so thick, they caused a significant reduction
in the amount of milk that babies received from the breast, with a resulting
drop in milk production and lowered weight gain in the baby. Babies
also became "addicted" to the rigid shape and feel of the
shield, and often refused to nurse at the breast once mothers started
using the shield. There has been at least one law suit settled in which
a mother sued a hospital for handing out a shield without appropriate
instruction and follow up on the risks of weight loss in the baby. Due
to these concerns, some hospitals began requiring the mother to sign
a consent form stating that she understands the risks involved before
they will give her a nipple shield.
For many years, shields were used infrequently
by health care providers, so very few of them learned the techniques
involved in using them appropriately. They got such a bad reputation
that it was often almost impossible to find them, and most lactation
consultants hesitated to recommend their use, even in cases where it
might have been helpful.
However, things have changed in the past several years.
Newer shields made out of thin, flexible silicone were introduced. These
significantly reduced the reduction in milk transfer caused by thick
latex shields. Also, new research has been done that has shown that
shields can be very useful and can even increase milk transfer in certain
Some of the most interesting studies have been
done with premature babies. Preemies often have trouble staying attached
to breast due to a weak sucking reflex. They don’t have the strength
to maintain the negative pressure that holds the nipple in their mouths,
so it tends to slip out after a short time on the breast. Many preemies
exhibit immature feeding behaviors, such as short, ineffective bursts
of sucking, and have trouble maintaining longer bursts of sucking.
Preemies also have a tendency to fall asleep at the breast almost
immediately after beginning a feeding. All of these factors contribute
to the fact that premature babies often don’t obtain enough milk by
breastfeeding alone, and measures such as stimulating the mother’s production
with a pump or supplementing with formula become necessary.
One recent study showed that babies from 25-37 weeks
gestation, and weighing between two to over six pounds when they started
breastfeeding, took in much more milk at each feeding when they nursed
with a shield than they did without it – nearly 4.5 times more. The
shield seemed to help by giving the tiny baby a firmer surface to grasp
and hold in his mouth, so he doesn’t "fall off" the nipple
when he pauses between sucks. This keeps him on the breast longer, and
increases the transfer of milk. Shields also help smaller babies attach
effectively to large nipples and to remain attached longer so that they
receive more milk. The average amount of time that mothers in the study
used the shields was 32.5 days. The mothers used the shield for an average
of about 24% of the total time they breastfed. How long they used the
shield had no relationship to how long they nursed their babies.
Another study suggested that the typical baby
will need to use the shield until he is at full-term, corrected age.
This means that most preemies will use the shield for several weeks.
Although I understand your desire to get your
baby off the shield as soon as possible, there is no medical reason
to rush it. It may be that your baby needs the extra help with
milk transfer that the shield provides at this time, and just may not
be quite ready to "graduate" yet. She may need to get
a little stronger, gain a little more weight, and grow her tiny rosebud
mouth a little larger before she can handle nursing effectively on your
large nipples without some help from the shield.
Assuming that she is ready to make the transition
to breastfeeding without the shield, here are some techniques you can
use to encourage her to take the breast :
1) Provide lots of skin-to-skin
contact. Tuck her in a sling "kangaroo style". Try nursing
in the bathtub.
2) Offer her the breast without
the shield when she is sleepy. Babies are often less resistant to trying
something new if they are partially asleep.
3) Start the feeding with the shield,
then slip it off and offer your nipple after the milk has let-down,
the initial breast fullness is lessened, and the baby has some milk
in her tummy to take the edge off her appetite and settle her down.
4) Put a tiny piece of damp cloth
in the tip of the shield to stop the flow of milk. Some babies will
take the nipple that is dripping with milk once they realize that sucking
on the shield isn’t going to do anything for them.
5) Don’t trim pieces off the shield
with scissors in an attempt to reduce dependence on the shield. This can
result in sharp edges that can irritate your nipple and the baby’s mouth.
6) Last but not least, be patient. Many babies who have become accustomed
to nursing with a shield may take weeks to make the transition to nursing
without it. A small percentage of babies never learn to nurse without
the shield, but this is rare. In these cases, the mother can still maintain
a satisfying breastfeeding relationship with her baby by feeding and
nurturing him at the breast. While shields do present a physical barrier
between baby and breast, they also allow mothers to feed their babies
from the breast as opposed to bottle, cup, or syringe feeding. The shield
does not preclude the physical closeness of nursing a baby, and is a
much more intimate method of feeding than the other alternatives.
Anytime a nipple shield is being used, the baby’s
urine and stool output and weight gain should be monitored closely.
Renting an accurate digital scale like Medela’s BabyWeigh scale which
accurately calculates the baby’s milk intake at each feeding can be
one way to know for sure whether your baby is taking in an adequate
volume of milk without the shield.
I hope that your little girl will soon make
the transition from nursing with the shield to nursing without, but
regardless of when (or if) that happens, you can feel good about the
fact that in spite of the challenges you encountered in the beginning,
you are continuing to provide her with the many nutritional, immunological,
and psychological benefits of breastfeeding.