Nipple shields are usually recommended to mothers for flat nipples or in cases in which there is a failure of the baby to effectively latch onto the breast within the first 2 days postpartum. They are also used for sore nipples, prematurity, oversupply, transitioning infants from the bottle to the breast, and other indications 5.
The physical design of the shield has drastically changed over time, dating back to the sixteenth century 6. The shield needs to be positioned over the center of the nipple. Each stretch of the shield draws more nipple tissue into the shield. The edges of the shield circumference can be secured over the areola with a few drops of water.
If the infant is latched onto the shield properly, each suck will show visible movements in the area of the breast distal to the shield. In contrast, little or no breast movement is visible with sucking if the infant is only on the tip of the nipple shield 8. The use of nipple shields is a controversial topic in lactation. Its use has been an issue in the clinical literature since some older studies discovered reduced breast milk transfer when using nipple shields 9 — Nonetheless, more recent studies have reported successful breastfeeding outcomes following the use of nipple shields 4 , 7 , 13 — Nipple shields are not only debated among healthcare professionals but also among mothers.
The shields may act as a solution to a problem, thus reducing the stress from breastfeeding difficulties, or it may increase stress when women aim to breastfeed without accessories To provide a foundation of evidence for the use of nipple shields, this review was undertaken to evaluate the evidence and outcomes associated with nipple shield use.
A full list of search terms is provided in Figures 1 — 4. Titles and abstracts were screened to identify if studies were relevant for full-text screening, after which full texts were included if they met the pre-specified inclusion criteria. Articles were selected for full-text screening if the title or abstract mentioned nipple shield s.
Only English language studies were included. Duplicates of articles found in each database, as well as non-original research, small i. Of those, 31 articles were identified for full-text review as specified by the inclusion criteria; 17 of the 31 articles were rejected after full-text review.
Three studies reported on the physiological responses during breastfeeding with a nipple shield 9 , 10 , Amatayakul et al. At 1 week postpartum, prolactin and cortisol levels, infant suckling time, and milk transfer were measured with and without a nipple shield. Use of the nipple shields when breastfeeding had significantly reduced milk transfer, from a median of 47 g in group 1 to a median of 27 g in group 2, which was likely due to the inhibition of oxytocin release in group 2 mothers 10 Table 1.
Auerbach 12 also examined milk transfer with a nipple shield. Twenty-five mothers participated in two separate pumping sessions, one for each breast, where different designs of nipple shields were tested. Pumping without a shield yielded larger amounts of milk, with mean volumes six times greater than when the old shield was used and more than four times greater than when the new shield was in place. Woolridge et al. This nipple shield design increased sucking rate and the time spent resting.
In contrast, minimal differences in sucking frequency and pauses were observed when using the thin latex nipple shield 9 Table 1. Two studies reported the breastfeeding outcomes with nipple shield use for premature infants 2 , Clum and Primomo 2 performed chart reviews for 15 premature infants who were neonatal intensive care unit NICU patients and whose mothers intended to breastfeed.
It was identified that health professionals usually recommended nipple shields if the neonate had difficulty latching for an average of 5 days. The average gestational age at first nipple shield use was Meier et al.
This study examined the effect of nipple shields on milk transfer and total duration of breastfeeding. The volume of milk transfer, which was measured by infant test weights, was compared for two consecutive breastfeeding one with and one without the use of a nipple shield.
When using the shield, all infants consumed more milk than without nipple shields. The mean transfer of milk without a shield was 3. These infants used the nipple shield for a mean duration of 33 days, which was a mean of Of these studies, four were prospective 3 , 13 , 18 , 19 and four were retrospective 4 , 7 , 14 , Chertok et al.
Part 1 consisted of 32 breastfeeding mother—infant dyads that had received support from lactation consultants and had used or were still using nipple shields. A structured telephone survey was used to examine maternal satisfaction with nipple shield use. Overall, mothers were satisfied with nipple shields and attributed its use with preventing early weaning 18 Table 3. The study population included five maternal—infant dyads that had completed Part 1 and were in the process of weaning from nipple shield use.
Therefore, nipple shields were an effective intervention strategy that did not affect milk transfer or hormone levels and could prevent early breastfeeding termination 18 Table 3.
Chertok 3 conducted another telephone survey in , which involved 54 maternal—infant dyads from the United States of America and Israel, who had experienced nursing with and without nipple shields during the postpartum period. Mothers were surveyed at birth and 2 weeks, 1 month, and 2 months postpartum in order to determine how nipple shield use affected infant weight gain.
In total, Data were collected from all groups before hospital discharge and at 3 months postpartum. A 3-month interview was carried out by telephone or a questionnaire was sent by mail to investigate the feeding method at 3 months and problems experienced between hospital discharge and 3 months postpartum. It was found that more than half of the women in each group continued breastfeeding at 3 months, and the majority were breastfeeding exclusively.
In a final prospective study, Pincombe et al. Three hundred seventeen mothers who were intending to breastfeed and had given birth to their first at term baby in an Australian hospital were included in the study.
A total of A higher rate of weaning was found among mothers who used artificial nipples e. Other factors that led to increased risks of breastfeeding termination were breastfeeding on demand in hospital and midwives teaching mothers how to initiate breastfeeding. Similarly, breastfeeding duration was shorter for women who did not experience all of the BFHI practices 19 see Table 3.
Four retrospective studies comprised two chart reviews and two telephone surveys 4 , 7 , 14 , Boldey and Powers 7 conducted chart reviews for 10 mothers who used nipple shields. Drain, dry eg with paper towel and store in a clean covered container that has been cleaned in the same way. When it comes to weaning off a nipple shield, many mothers find it helpful to seek the support of a breastfeeding counsellor or lactation consultant.
Some mothers find that weaning off a nipple shield can be a bit tricky. Some tips that can help when it comes to weaning off a nipple shield include:. Breastfeeding: Breast and Nipple Care tells you what to expect as your breasts change during pregnancy and briefly covers how breastfeeding works. The information on this website does not replace advice from your health care providers. Nipple shields What is a nipple shield?
When is a nipple shield used? How to use a nipple shield When using a nipple shield, it is important to learn how to use it properly. Tips for using a nipple shield: Express a few drops of your breastmilk onto the inside of the nipple shield. This will help prevent chafing and help to improve the seal that the nipple shield makes with your breast. Express a few drops of your breastmilk into the tip of the nipple shield, where the holes are.
This will help encourage your baby to attach. Stretch the brim of the nipple shield somewhat outwards. Keeping the brim stretched, place the nipple shield centrally over the nipple, onto the breast, to help draw some of the nipple and areola into the crown of the shield as you release the stretch. Hold the nipple shield in place with your fingers on the outside edges. There should be a small space between the end of your nipple and the end of the crown of the nipple shield.
If your nipple touches the end of the crown of the nipple shield, then the nipple shield is too small for you. Point the crown of the nipple shield at your baby's nose and encourage your baby to open his mouth wide. A lactation consultant or breastfeeding counsellor can help you make sure that your baby is attached to your breast well and that he is getting your breastmilk through the nipple shield. The following points will help you to recognise if your baby is attached well: His mouth is open wide.
His chin is in pressed into your breast. He has a good mouthful of your breast, with his lips over the brim of the nipple shield, not just the crown portion. What's Included. General Made of thin silicone Dimensions Unit Weight:. FAQs What is the diameter of the nipple shield at the base? How do I sanitize the nipple shield?
Rinse in cool water to remove breast milk. Wash in warm, soapy water. Rinse with clear water. Note: Nipple shields can also be washed on top rack of dishwasher. If boiling your nipple shield: 1.
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