An epidemic of nipple shields as "treatment" for breastfeeding problems
What can be done for this mother and her 5 hour old baby who will not latch on? I saw this baby whose mother had had 3 previous babies who never latched on. Her other breast is essentially the same. I helped the mother with latching on and the baby latched on and breastfed well.
Many such mothers are started using a nipple shield before even leaving the hospital. Some started on the nipple shield even before she tried the baby on the breast, one such mother telling me that the nipple shield was started immediately while she was still on the delivery table. As is true of most such mothers, they don't like using the nipple shield. It's not breastfeeding.
I believe the answer is likely that such mothers are told by hospital staff that feeding a baby through a nipple shield is just like breastfeeding. It is not. It is just like feeding a baby with a bottle. The result? The baby becomes more and more resistant to taking the breast, and the mother's milk supply and flow diminish rapidly.
The use of nipple shields has become almost epidemic in North America and Europe. Nipple shields are seen as the answer to virtually?all?breastfeeding problems, from babies not latching on, to nipple soreness, to?routine?use for premature babies. Even the perception of a mother’s nipples being “flat” often results in the recommendation of a nipple shield sometimes without even an attempt to latch?the baby at the breast. Mothers attending our clinic have told us that they were given a nipple shield immediately after the birth of the baby, before they even attempted to put the baby to the breast.
The nipple shield is a recommendation without regard to the long term, not only when recommended in the first few days but even in the mother whose baby has started to refuse the breast due to?late onset decreased milk supply?when there are more effective treatments. But it is particularly pernicious when used to get the baby to take the breast when so many babies who do not latch on during the first few days would easily latch on when the milk supply and milk flow increase on day 3 or 4, especially if the mother is helped by someone skilled at helping with?latching on. The questions that are not asked are: “How will a mother whose baby is on a nipple shield continue breastfeeding long term?”, “How will the mother in such a case be able to stop using the nipple shield?”, “What will the effect of the nipple shield be on her milk supply both in the short and?longer term?”, “What are other side effects of the use of nipple shields?”. And “What happens to these mothers and babies when they forget the nipple shields on leaving home with the baby who otherwise does not take the breast?”
The most important question is whether something else could have been done instead of introducing a nipple shield. I am convinced, based on 38 years of helping mothers with breastfeeding that?there is nothing that can be done with a nipple shield than cannot be done better without one.?If a baby can latch on to a nipple shield, the baby should be able to latch on to the breast. The problem is that the more nipple shields are used, the less experience people have applying or searching for?alternative solutions, including learning how to?help a mother help her baby latch on. The nipple shield solution?seems to be an attractive one because it?appears?to work quickly, indeed, immediately, in most cases. We do love quick solutions.
Unfortunately, patience, skill and experience?are necessary to solve some breastfeeding problems; both the mother and the person wanting to help her need to be patient. There is nothing terrible about waiting a few days to get a baby to latch on, if, in the meantime, the mother is given the tools to apply during this time.?Even newborn babies can drink from an open cup and or be fed from a small spoon. I would also suggest that a large part of a lactation consultant’s work is to counsel the mother and part of this is to counsel patience and provide a temporary solution that leads to successful breastfeeding long term. Let me propose that for each problem for which a nipple shield is used, there is a real solution which takes into account the long term perspective.
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Incidentally, or not incidentally, I helped the mother in the photo above to latch the baby on. The baby did latch on and drank well.
See this article https://ibconline.ca/nipple-shields/ for more information.
Please consider buying and recommending my new book, What Doctors Don’t Know about Breastfeeding.
?Print version and ebook version on Amazon:?https://www.amazon.com/dp/B09WC2HCC6
?Print version on Praeclarus site:?https://stores.praeclaruspress.com/what-doctors-dont-know-about-breastfeeding-by-jack-newman-and-andrea-polokova/?showHidden=true
?Jack Newman, MD, FRCPC
Consultante en lactation, dipl?mée IBCLC, certifiée animatrice LLLF, dipl?mée master 2 RNCI coach-consultante.
1 年If a baby's tongue and jaw are mobile, free of restrictions, this nipple would not be a problem for him. He'd be able to open his jaw wide, stick out his tongue, and bring the nipple to the back of his mouth (where it doesnt hurt the nipple) and the mobile tongue and jaw would empty the breast. Its quite possible that the nipple is not the problem here but a tongue and or jaw restricted in mobility, whatever the cause may be, restriction in the cervicales, the occiput, restriction in the fascia and yes, of course there is the obvious possibility of an unidentified frenum, but using either the ATLFF or the Roberta Martinielli tool or Carole Dobrich tool would probably make that easy to figure out.
Maternal Child Health Advocate, Licensed Midwife, Lactation Consultant, and College Professor
1 年I wholeheartedly agree with this article. I see it so often and no conversation is had with the mother about the longterm plan or what will happen if they leave the shield at home on accident.
Director of Lactation
1 年It would be helpful to see videos of a mother latching in cases like these.
BSCH, RN-IBCLC, Reproductive Justice Advocate
1 年In an American hospital setting, sometimes a shield is the only thing that keeps a baby at the breast until they go home and can see an IBCLC after their milk fully comes in. While I agree it's better to keep trying without a shield, staying skin to skin, etc, hospital policies and pressures do not allow for this. They want calories going in from hour 1 (despite all the evidence), and in my experience, if the baby is at least latching with a shield, the family is less likely to be pressured by pediatricians to give bottles of formula due to "poor feeding." I've worked in both hospital and private practice settings and it's my opinion that shields are largely a mental crutch or placebo, but sometimes that's just what a new mother needs to get through the hospital stay where they are undergoing lots of other stressors besides latching. Systemic change is nowhere on the horizon in terms of institutional breastfeeding support, so to me it's not really worth taking away another resource when it may provide hope and perseverance (even if placebo effect!)