January 19, 2009 — Elizabeth Jay

I have spoken to many mothers, including two midwives, who have used shields to ease nipple pain while they are breastfeeding without any apparent problems for their babies. Although they have been described (in the words of one mother) as ‘a godsend – the thing that made breastfeeding bearable for me,’ they are not recommended by the National Health Service.

What’s the problem with using nipple shields? Well, an NHS Primary Care Trust Breastfeeding Policy document cites two studies demonstrating slower milk transfer when using a shield1,2.

The trouble with this research is that it was conducted over 25 years ago, and shields have moved on in that time. A more recent study (published in 2006) test-weighed babies after feeding with or without a thin silicone shield and found that there wasn’t any difference in their milk intake3. The same article reports the results of a survey of mothers’ attitudes to using nipple shields and found evidence that they actually help to prevent early breastfeeding termination, rather than cause it. Another survey of shield use found that 86% of women utilizing them felt that they allowed them to continue breastfeeding when they might otherwise have given up4.

One study investigating the impact of a number of factors on nursing duration initially appeared to link using a nipple shield in hospital with a greater risk of discontinuing breastfeeding5. When other factors known to affect breastfeeding duration (such as the type of delivery the mother had and whether she smoked) were taken into account, however, the relationship between shield use and early weaning declined to the extent it was no longer statistically significant.

It has been suggested that using a shield from very early on could cause nipple confusion, meaning your baby wouldn’t want/be able to feed directly from the breast. An instance of this was reported in a case study more than 20 ago, which described a baby who refused to latch normally onto the breast, having been taught to attach with a rubber bottle teat covering the nipple6. This case study, which doesn’t even really demonstrate the problem – a bottle teat is quite different to a modern shield – appears to be the only recorded evidence for shield related nipple confusion. According to an article recommending shields for feeding premature babies (a situation in which they have been shown to be very useful), ‘the term “nipple/teat” confusion remains a hypothesis,’ i.e. it might be a problem, but there isn’t yet any strong evidence to support it7.

Using a nipple shield won’t necessarily be trouble-free: you have the hassle of cleaning, sterilizing and applying it before each use, not to mention remembering it when you go out. Despite these drawbacks, some mothers undoubtedly find shields very helpful. Women who choose to use them are already experiencing breastfeeding difficulties, such as nipple or latch problems, and are therefore at greater risk of stopping anyway8. When the alternative to a nipple shield is a bottle, perhaps trying one isn’t such a bad idea after all.