Study design and setting
Nipple shield in a liminal time
‘Good enough’ breasts
Why use it when it’s equally good without? All babies mature at different paces. Much of this is about our attitudes. I can say that “Yes, you can use a nipple shield sometimes as a temporary remedy or during the whole breastfeeding period. It’s different for different mothers and babies.” And then I talk about how it can be and what babies are capable of. I often say “You have perfect breasts” because really, there are only perfect breasts. Babies can suck on a flat surface so it’s not a hindrance if the nipple doesn’t stick out like a teat. I know that some think that you should use it early, but I think differently. Mothers get a feel that their breasts are not good enough.
Something in between
I had just breastfed a few times. She [a nurse] looked and said “she has a bad latch-on”. I didn’t think it was that bad. They [staff] went and got a nipple shield. It wasn’t a suggestion; she just got it as it was the most natural thing to have. I try to remove it when they are hungry but not angry. It’s greasy, you wash them and then it’s goo in them. The breasts feel so clean. And it’s breastfeeding that I have longed for. You don’t feel that close. It’s a sad feeling, it’s a thing. It’s something in between us.
I tried it because the mother next to me tried it because her daughter slipped off the nipple. So I thought it would suit us but it didn’t. It was a new taste sensation for her [daughter], the plastic, and she didn’t look content at all.
Mother: Dad thought the nipple shield was messy but I thought it was security. This time I tried without it but he just sucked a few times and then lost the nipple. Then dad fetched one [nipple shield] and he got half of the assigned milk volume straight away [the son was weighed before and after breastfeeding]. With a nipple shield you park it in the mouth.Dad: Now I think it’s [nipple shield] great.
Excerpt from field notes:Mother is sitting in a reclining chair reading the newspaper and is getting ready to breastfeed. The father is standing by the washbasin cleaning the nipple shield. The mother lifts up her son from the cot and cuddles him.Mother [screaming fairly loud]: Now you have to help me! Mum needs help with the nipple shield!Dad hurries and she places the nipple shield onto her breast.Mother: I’m not so keen on the nipple shield. It’s so flipping difficult. You should attach it properly and he needs to be in a good position and get it right. And I get so stressed. It’s great if he gets it in to his mouth and sucks.The nipple shield falls off as soon as the son starts to suck. She places the son in her lap and attaches the nipple shield again, while the son is screaming. She starts to breastfeed again. After about 10 min she takes him off the breast and gives the nipple shield to the dad who cleans it. She shouts to the dad to hurry up and when he gives her the nipple shield she attaches it to the other breast and starts to breastfeed. After 5 min she takes him off the breast. The father checks the position of the tube by a syringe, which he is supposed to aspirates some milk in. He states that there is “nothing” and asks a nurse to check who as well find no milk. Although encouraging words from the nurse that “it does not mean that he has not received any milk by breastfeeding”, the mother walks out disappointed to express milk by a pump.
They gave me this [nipple shield] and it stimulates the hard palate. In the beginning it came off and it was hard for him to accept it. On day 3 and 4 I tried without it and he sucked then as well. To me it feels more natural without. But from the unit they want me to have it.
Mother: I had a nipple shield with my older child ‘cause then I had an ulcer on the nipple. Some staff are so pushy to use it. Before [birth] I didn’t think I would use one unless I had problems. But now they want mothers to use them right from the start. They should learn quicker because it stimulates the palate and then it stimulates the sucking.Researcher: What do you think?Mother: I think it’s very individual. Maybe it takes another week. It is better that he can suck and lick as he wants it. I’m not going to prize open his jaws.
Short term solution
When I don’t have it, they are laying there searching and if they find it they suck a few times and then become tired. It’s instinct. With a nipple shield they know what to do, they eat and swallow. You have to prioritize; the most important thing is that they eat.
If I’m not going to work for a week and I think that a mother would breastfeed exclusively by tomorrow if she gets a nipple shield, I feel that I have to save them from a failed breastfeeding, because I don’t know what will happen if I’m not here. Someone might suggest a bottle. Then it’s better if I give her a nipple shield and with a nipple shield you often get a revolutionary rapid result. If a mother is sitting there with an infant in week 33 who shows rooting but just sucks a few times, then it’s easy to wean. She becomes hesitant to breastfeed because she doesn’t get a response. It gives the mother the response she needs when the infant sucks. And then I can walk out of here without anxiety. If we were to take the nipple shields away, a lot of mothers would start bottle feeding instead.
There are cups to use for feeding and there are nipple shields but there are no bottles to be seen. Bottles are really forbidden. And really, there shouldn’t be such a difference. I know that the babies shouldn’t get used to a bottle because then they can’t suck on the breast. But it can’t be that much of a difference between sucking on a nipple shield or a breast.