Impact of Nipple Shield Use on Milk Transfer and Maternal Nipple Pain (Article Review)
My first encounter with a nipple shield was with my daughter, Cassidy. It was given to me by a lactation consultant who came to my house when Cassidy was a couple of weeks old. The lactation consultant gave me the nipple shield to use because it was difficult for my infant to latch on, an “oronipple mismatch” as she said, or at least that is how it was explained to me. All I knew was that I had sore, cracked nipples and feeds were extraordinarily painful.
So what is a nipple shield? A nipple shield is a thin plastic dome placed over the nipple and areola during nursing. These little flimsy plastic things are somewhat controversial. Nipple shields have been used for flat or inverted nipples, sore nipples, or when there is difficulty obtaining a latch. Now there is lots to be said about whether or not the recommendation to use a nipple shield is appropriate, most clinicians viewing their use as an indication of improper latching (which can be addressed in its own right). Another concern is that nipple shield use reduces milk transfer.
A recent study sheds some light on the issue. An article in the March 2021 issue of Breastfeeding Medicine, The Official Journal of the Academy of Breastfeeding Medicine (doi: 10.1089/bfm2020.0110), looks at nipple shield use and milk transfer. The study took two groups of breastfeeding women— one group that was not experiencing any pain (control) and a group that was experiencing pain with nursing (pain group).
What they found may surprise some people. The study concluded that shield use did not impact either milk production or milk transfer in breastfeeding women experiencing nipple pain. Score a point for nipple shields— no decrease in milk transfer for those seeking relief from discomfort!
But there’s a catch when looking at the data more closely. If the nipple shield was being used to address pain, the data did not demonstrate a significant impact on the discomfort. And for mothers where breastfeeding was not painful to begin with, the use of a nipple shield did significantly decrease milk transfer and feeding efficiency.
Honestly, I do not remember the nipple shield being a game changer for me all those years ago. So where does this leave me now as a pediatrician and looking at the latest literature? This study does not change my opinion of nipple shields much. In women where there wasn’t an issue to begin with, this study supports their usage decreases milk transfer and feeding efficiency. And for mothers with nipple pain, although it didn’t decrease the amount of milk transferred, it didn’t significantly change the pain the mothers in the pain group were experiencing.
Basically, if mothers are looking for relief from nipple pain, nipple shields may not be the solution. What these mothers really need is a way to manage sore, painful, or cracked nipples, and also how to prevent nipple issues from occurring in the first place.
