EPISODE 84

Let's Talk Nipple Shields!

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Episode Transcript

November 19, 2021

How do you use nipple shields? Can they help?

This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.

 

So join us for another episode. Hello, everybody. Welcome back to The Milk Minute Podcast, we are trying something new today. We are remote recording, but in a professional way and hoping for the best. Yeah. We’re hoping my internet holds up and that we don’t have like awkward timing issues and you know, all of that.

So bear with us. I hope it’s great. It’s only like the 45th brand new thing we’ve tried to do this year. So what could go wrong? They’ve all worked out perfectly. Oh gosh. Well I did two exciting things this week. What did you do? One is I started watching Working Moms on Netflix. Oh my gosh I love that show. Yes. And honestly, I’m, I’m only like two or three episodes in right now.

What I love most about it is the like super real representation of postpartum depression and like suicidal thoughts in, in like a hilarious way where she’s like, I’m not thinking of driving the plane into the ground, I’m just thinking of like how nice it would be if somebody else did that while I was in it.

And you’re like, that is pretty much exactly how that goes. Yes. So if you feel like that, let us know. I went all the way to season four. I just finished season four. And spoiler alert, but not really, like, she takes a picture of her downstairs place. Like her holes. She does a whole picture and accidentally sends it to the wrong person.

Hell yes. And I just I’m like, this is kind of, don’t you feel like you’re living a double life, like when you are, you’re a high-powered person who’s like constantly running. You’re in charge of incredibly important things like the birth of other people’s children, yet when you’re in the car on your way to go birth someone else’s child and you feel your breasts filling with milk and you need to stop and pump, it often feels like this inner struggle of like priority.

And it’s like, who are you? Are you this person or are you this person? And it’s like very strange to live those two worlds in the same person for that period of time. Absolutely. Yeah. It’s, it’s pretty crazy. Cause you know, when you’re still breastfeeding a baby and you’re at work and you’re pumping, it’s like, you can never turn it off.

Right. You know, and I know it’s hard to do with an older kid to turn off your thoughts about them. But like, I would go to births, you know, when Griffin was like four and not think that much about him, you know, I could compartmentalize and put it away. But yeah, like when you’re having this physical manifestation of the child that you left behind, it’s very hard to do that.

It’s like forced presence. Yeah. And that’s hard where you’re like, I don’t. Listen, when I sit down to work and I’m at my computer and I’m working, I get annoyed if I have to poop, like if I have to poop. That happened soon as I got here tonight.

Same thing where your body is constantly like, oh, that’s nice that you had plans. You’re also hungry and you have to sleep and you have to milk and you have to take a shit. I get mad when I have to pee when I’m working. Me too, just like, God, again? But then again, how messed up is that, that angry about that?

Well, yeah, and that’s not us being messed up. That’s like our society being messed up, right. That we’ve been like trained to ignore our bodies and be like pissed off at totally normal things that we’re doing to stay alive. Be like the horse that’s pees anywhere. It doesn’t matter who is standing next to them or if you’re on the job. Could be a romantic thing and you’re just peeing everywhere.

The funny thing about horses is they continue walking when they poop, but they stop walking to pee. Why? I don’t know. They don’t like to get pee on their legs? I don’t know. They just, they just do. Maybe it would feel good to stop and enjoy this horse pee moment, man. Well, anyway, the second exciting thing is related.

I finally got my Elvie Stride in the mail. Oh yeah. And I used it for the first time today and I have lots of thoughts and opinions and I’m going to make a TikTok video about it, which also in case you guys didn’t know we’re on TIKTOK now. We’ve already been banned four times, right? Like we’re there and sometimes we’re allowed to post if, if we remember not to show too much skin or talk about body parts or cuss, or like do other random things that are unclear.

Which are also pretty much the top three things that we do all the time is show skin, talk about body parts and cuss. And it’s like, maybe that’s not the platform for us. If we’re going to keep getting restricted like this, you know what?

I’m okay with it. We’re going to be Tik TOK, rebels. We’re good. We’re just let’s keep at it. Yeah. It’s just going to be spotty. So hang in there as we try to figure out how to bend a more rules. I’m just here while we’re restricted again, making drafts, and then I’m going to post like 10 videos at once. And then hopefully if we get restricted again, at least there’s new content.

Yeah. Watch us try to muddle our way through this. Anyways. It’s fine. We do have a thing today that we were going to talk about. We were going to talk about nipple shields, right? Yeah. Speaking of controversy, nipple shields. Very controversial. Yeah. But you know, before we get into that, we have a couple of things we need to do.

Questions. But also before that, I want to take a minute to thank some patrons because we have a lot of new patrons and I’m so excited about it. And I’m just going to thank them all right now. So thank you, Molly McMillian, Katie Siegfried, Lauren Wheaton, Jacqueline Kelly, Brittany Petta and Rachel, who are all of our new patrons.

They are giving us a little bit of money every month. We are giving them all kinds of special, personalized advice and videos and posts. And I’m so excited to have them. Thank you guys so much. Yeah. We’re loving it, and we love our live Q and A’s and just working with you guys one-on-one. Where every third Tuesday of the month we go live and we hang out with our Dairy Queens and, and we just love it.

I also have a very quick correction from a previous episode. Back in the community milk sharing episode we fucked up. When we were talking about gram negative bacteria, we accidentally listed gram positive bacteria as examples. It’s fine. My bad. It’s not really a big deal. It doesn’t really change the episode, but very sorry about that.

So thanks for catching that, Jacqueline. And yeah let’s hop over to a question, right? Yeah. Okay. Today’s question is from Whitney ma Kara Han. McCarren. I’m really sorry for how we say everybody’s names. It’s horrible. Yeah. My bad. Whitney sent us an email to our email address [email protected] which you are welcome to use.

She says, hi there ladies. My name is Whitney and my husband and I just welcomed our first baby 16 days ago. Congrats. I’ve been listening to your podcast for months and you have been so helpful in preparing me to breastfeed. Both of my nipples are inverted, so I’ve had to use a nipple shield since our son was born.

The shield works and my baby is getting enough, but I don’t want to use it forever. I have been to three lactation appointments and I’ve been told to pump more to help my nipples stretch out. That using the nipple shield will help train my nipple tissue to stay out and that if I continue to use the shield, my supply will go down.

Any advice on how I should move forward? I’d like to start transitioning to not using it, but I’m kind of lost on what will work. Really appreciate you both. Thank you. Whitney. Cool. So some of that we’re going to definitely get into in the episode on just like practical, how to get off a nipple shield. I did want to address one point though, where she says that the nipple shields will help train her nipples to stick out.

Cause I don’t think that she was given the correct information there. Yeah, we don’t really, not, I haven’t seen any of the evidence that says that nipple shields help train your nipples to come out. And the nipple shells that people are often recommended to wear prenatally, to quote, train your inverted nipples, to come out.

Also, the evidence says that that doesn’t really help. Yeah, it doesn’t really do anything and it actually can create nipple damage prior to birth because people go crazy about it. They’re like, oh my gosh, I have inverted nipples. I need to put this shell on and wear it 24 hours a day, which is not the recommendation.

But you know, when you’re trying to prepare to breastfeed and you’re freaking out, I mean, people do things like that. And then you show up to have your baby and your nipples are already kind of sore and damaged. And that’s really uncool. Yeah. The thing with inverted nipples too, is that we have different grades of inversion.

And if your nipples, after you have pumped or breastfed and you look at your nipple, if they are everted afterwards, you have a really good chance of having the severity of your inversion change over time and having baby latch without a shield. Something that can help though, in trying to get baby to latch without a shield is to use a pump or a latch assist right before getting baby to latch. A latch assist is basically, it looks like one of those little squeezy horns you have on your old bicycle or whatever, but essentially it’s just a flange with a little pump on it and it just pulls your nipple out.

So if your nipples evert at all, sometimes putting one of those on. I’m sure the haakaa would also work just for a few minutes before latching baby might help keep your nipple everted to begin with and then get baby on there. Yeah. So Whitney, I hope that helps. We are going to go a little bit deeper into all of the other parts of your question in the episode.

So thank you so much for your question. And of course, if you guys have questions, feel free to email us or find us on Facebook.

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Okay, well where do we want to start? Okay, well, first we need to clarify what we mean when we say nipple shield. Yeah, we do. So I was like, let’s really start at the basics today. People say nipple shield and can mean two different things, and that can be very confusing for people. So what we are specifically talking about today are nipple shields that have holes in the end of them, that baby can use to suck milk out of and transfer milk through.

The shells, we’re trying to call them shells now, but the old word was a nipple shield that just basically sat on your nipple and prevented them from rubbing and tried to help heal them from any damage that was done. So the shells are what we’re now calling them to differentiate. They look like a little seashell.

Yes, or also, they would call those the milk collectors. So with the milkies or the milk saver shells, those were also previously called shields. A third thing, people call shields are the flanges on pumps. So yes, to clarify, we are talking about the very soft, flexible shield that goes over your nipple that milk comes through and you wear while feeding baby. Yes.

It looks like a little nipple sombrero. That was not as simple as I thought that was going to be. Anyway. I know. I really thought that was going to be very clear. Who has a picture on Instagram? Yeah. So if they’re able to suck milk through it. Yeah. That’s a nipple shield.

If they are collecting it, it’s a milk saver. And if it’s a shell that goes on top to prevent your nipples from rubbing clothing, it’s a shell. Hooray. We did it. Yeah. Heather, do you think you can walk me down memory lane into the deep dark and probably sorted history of nipple shields? Yes. It was a long dark night in the 16th century.

Everything was muddy. I just imagine everything was very muddy back then. Probably actually it was poopy, like poop is just feces in the road. Yes. I saw this several places that we have evidence that nipple shields were manufactured as early as the 16th century, but I was actually unable to locate a source for any of that.

So somebody said that at some point in time, and that’s been quoted by lots of evidence-based research, but I couldn’t actually track down that source. Doesn’t mean it’s not there. It’s just like really buried. Right? Well, and when we were going through the history of breast pumps, way back when, I had found images of nipple shields from ancient Greece, or that’s what we assumed they were.

So I’m going to venture a guess that like these have been around for a long time. Right. And I think that it’s like, who would bother to write that down? You know, like the only people that could write back then were like religious people and they’re not going to be like, oh, you know what, definitely we need to document this nipple shield thing that people are doing these days.

This is helpful. And also, maybe people had a different view about children who couldn’t latch back then, you know, maybe it was just like, not what it is now. I’m just speculating. It’s hard to know. It’s very hard to know, but we do have a couple of museums that have some nipple shields that were donated by family members that just passed them down from generation to generation, which is so cool.

I mean, it’s cool. But also like sounds unsanitary. Well, I think it’s just so typical moms. Oh yeah, you’re going to need this. You’re like, thanks great grandma, Jean. Like, I appreciate it so much. Thanks for the ancient nipple shields. I really I’m definitely gonna use those. Made of fucking lead. Right. So 1850, we have some nipple shields and we’ll post pictures of these on Instagram, but they were made of many different things.

So they could be made of lead, wax, gross. Wood, also gross. Tin, animals skins or bone. But if you were wealthy, you could use silver or pewter and ivory. Oh. And I’m sure the glass ones were like leaded glass too. Yeah, I’m sure they were glass ones as well. So what this tells us again is that people have been struggling with this for a very long time and trying to find a solution to the point where they’re like cut up that sheep and bring me the skin and see if I can’t fashion that to my nipple and make the baby suck on it. And some husband out there was like okay. You know what though? I’m going to say while the wax sounds gross, like I can see that working because you can actually mold it to fit you.

Yeah. Maybe. Well, and it’s not like it’s going to melt at body temperature. I also wonder about the tips of those like really hard ones and what that did to the palette of the baby, because babies can get this thing called Bednar aphthae when you injure the area right between the soft and hard palate, it kind of turns into the world’s worst canker sore, and it takes forever to heal.

And it’s just awful. And it’s from repetitive motions, like bottle feeding or pacifiers, or the bulb syringe when they’re born. We like jam that in there and injure their mouth. So anyways, I just wonder about that kind of thing. I just wonder, like, who was the first baby to bite a glass nipple shield and break it in their mouth?

Oh, oh. And like lead re like re like really? But like, you know, there’s theories that the entire Roman empire fell because of lead poisoning. Really? Because everything was made of lead.

Oh, that’s very funny and not funny, but, but also like funny in the way that it’s like, what are we poisoning ourselves with right now that’s going to take us down? Yeah we’re going to find out in 500 years. They’re going to talk about it someday like we’re idiots. Yeah. Anyway, anyways, positive topics around here.

Yeah. So the two museums that I found that have these ancient nipple shields are Cape Fear Museum in North Carolina, which I’ll link in the show notes. And another one is the Museum of Health Care, which I will also link at the show notes. That’s super cool. So it’s hard to imagine when you’re going through a nipple issue or a latching issue that many people before you have had the same feeding difficulties forever.

And that it’s not just you that’s white knuckling the arm of the couch when you’re trying to latch your baby through a nipple injury. So, you know, I hope that makes you feel a little bit more normal and not like your body is devolved or something. Like this is clearly something that has been an issue.

But just as an aside, if you do have a nipple injury for this, I still like the modern nipple shell called Silverettes and I’ll put our affiliate link in the show notes there. And these are a great investment if you’re on like your first baby and you plan to have a couple more, because they are actually made of silver, which is an anti-microbial property and you can put them in the refrigerator and they can be a little bit cold when you put them on after a feeding, which can help.

And they can also prevent any medication that you’re putting on your nipple from soaking into your bra, which is great. So it kind of keeps that moist wound healing there. So I really love Silverettes. I keep them around all the time. Yeah. And you know, like, I don’t want to start off this episode, like totally knocking nipple shields, right.

Because yeah, you’re right. Like this has happened. Babies have had a hard time latching for a long time and it’s not just humans. It happens in other mammals too, but their babies just die if they can’t eat. We’re really lucky that we have really big brains and we have been creatively figuring out solutions for clearly many years.

Yeah. I think the, the point in the road where it gets weird and becomes a sticky wicket is when it becomes normal for everyone to stick it on their baby registry and expect that they’re going to need to use it or that they should use it. Because I’ve had people say, when am I, what am I supposed to start using my nipple shield?

And I’m like, what? And they’re like, yeah, I got it in my baby shower. And I’m like, what? No. Okay. That is a medical device. It should be treated as such. So what I do, what I did once. I was like on social media and there was some parenting group at one of those like community baby shower events, giving away free baskets.

And they posted a picture of their breastfeeding basket. And there were like two packs with nipple shields in there. And I immediately private message them and it was like, take those out, take them out. Right now. And they were like, oh no, you know, we just want to give free things to parents without resources.

And I was like, no, this is like giving a free can of formula out at the hospital. Like, what are you doing? Yes, we should have these available for free, but only when they’re needed. Like I dunno. Anyway, they were just like, okay, crazy person. We’re not answering your DMs anymore. They’re like, this is what happens when we try to help people. Anyway.

So I like to think of the nipple shield almost the same way as I think about epidurals. I am not against epidurals at all. I got one with Heidi when I V-backed. It’s just, if we are trying to get a vaginal delivery and that is the goal, we are going to do an epidural sometimes to make sure we can get to that goal.

And a nipple shield is the same thing. So we are using a nipple shield to ensure that the breastfeeding relationship is maintained. So if there is something getting in the way of your breastfeeding relationship, for whatever reason, we can use that nipple shield like a wrecker, that’s going to get you out of the car when it’s all mangled, you know, it’s like, okay, whatever, let’s just get this over with, get over this hump.

We can get back to doing what we were doing before. Not like, okay, now I’m a nipple shield user, and this is who I am, and I’m going to use a nipple shield forever. Great. It’s a tool. It’s a treatment, you know? And when we think of it like a medical treatment or a medical intervention, then the way that we use it as more appropriate.

Right. And I think that is where lactation consultants kind of get irritated, especially ones that work in the community side because the lactation consultants that work in the hospitals doing like breastfeeding triage in those first couple of days of life, they are using it for a reason. But then they sometimes maybe because you’re postpartum and tired or maybe they forget to tell you, they forget to tell you when to stop or how to stop.

Yeah. And then we end up seeing them on the community side and it’s six months later and people have supply issues and we’re like, whoa, what the heck? And they’re like, oh, I wasn’t supposed to use this anymore? And you’re like, why, what? Yeah. And I mean, not to mention, they’re just a pain in the ass. Oh, like one more thing to wash and sanitize.

And remember when you leave the house. Dude, when I had Theo, for some reason, I only had a nipple shield on the left. I couldn’t get him to latch on the right. Now I realize he probably had oral restrictions and all kinds of other issues going on with his torticollis. So if you haven’t checked out our episode on oral restrictions yet, please do, because it’s amazing. Because Michelle was the best guest ever.

And we learned so much from her. Yeah. So, okay. So this is a tool we’re going to use and not to solve a problem, but to get to the point where we can problem solve. So it’s like, you know, putting the donut on your car when you have a flat, right. It’s going to get you to the point you can put a new tire on.

So let’s talk about some of those problems that we might use this for. Yeah. So first and foremost, by the way, I’m going to make a side note. Do not use these in the first 24 hours after your birth. There is absolutely no reason to use a nipple shield in the first 24 hours after birth. Period. Yeah, it’s a tough one.

Anyway. I mean, let’s just get, I mean, because we’re not supplementing in the first 24 hours for normal healthy infants, I’ll say that. You know, so for normal, healthy infants, we do not need to be using nipple shields because we are not at that point yet where we’re going to call a baby one way or another, like, oh, it’s not a good feeder.

Or, I mean, you can look and see that someone has inverted nipples, but at that point, like we’re going to do some other things first. We’re going to see if, give baby a chance, you know, maybe they just get on there and then problem solved. You know, we’re never going to give people a problem that isn’t a problem yet.

Right? Yeah. So in an ideal situation, we’re going to try for 24 hours without one. Yes. But then one of the first reasons people use them is engorgement, which we typically see like day two, three, four after birth, because when our breasts are so full of milk, that we would call them engorged, often it creates a flat nipple surface.

Yeah. As I like to say, it’s like trying to latch a baby onto a kneecap, and it’s very difficult to do. There’s like nothing for them to latch onto it. Just flattens your nipple completely. So having a nipple shield on there can give the baby something to latch onto, which allows them to transfer some milk, soften the breast, and then we can remove this shield and wipe the breast off so it’s, you know, dry. Because it’s also hard to latch them onto a slippery boob. Try again, after your breast is a little bit softer and maybe your problem is solved. You might only need it for like that one or two feeds. Yeah, for sure. All right. Throw out a reason. What’s another reason we’re going to use them?

Oral restrictions. So period. If your, if your baby has a tongue that’s completely restricted or a lip that is so restricted, that they absolutely cannot flange that lip out, and they’re doing more of a chomping motion or overcompensating than some way, because of a restriction, it can make it very difficult for them to latch onto a nipple.

And that hard plastic piece can actually reach all the way back to their pallet and trigger a sucking reflex, which is also part of the problem with engorgement and also flat and inverted nipples. As those nipples can’t get back there far enough to trigger that sucking reflex. Hand in hand with oral restrictions comes nipple pain, right?

Sometimes whether it’s due to a restriction or something else, we just have so much nipple pain we need a break. And we might use a nipple shield for a couple of days or every other feed, just so that we can manage that pain. Yeah, absolutely. But also I like to tell people, depending on the oral restriction, a nipple shield could potentially make it worse.

Yeah. So they, if it works, great. If not, it’ll look like a chomping motion where they actually are then biting, cause they can’t use their tongue to compress the plastic either. And so they end up chomping on the tip of your nipple and please do not stick that out. If it is painful where you’re like, oh my God, you break that latch and try something different.

Yeah. Let’s see, what’s next? There’s also weak suck or short, ineffective sucking bursts. And we’ll see this in late pretermers for sure. And premature babies. So nipple shields can help by increasing the duration of sucking because some of the milk that they remove stays in the tip of that nipple shield in between sucking bursts.

So then when they go to suck again, it’s right there and they don’t have, they don’t panic as much and it kind of calms them down a little bit. So it’s good for impatient babies who are also trying to get more volume in. So the premature ones that have the weak suck, we’ll actually see a higher volume of milk transferred with the use of a nipple shield in the short-term. Right.

Yeah. And then too, sometimes if we have an oversupply a nipple shield can really help because it just slows down how much milk is coming out. It makes it easier for baby to pace that instead of getting like the firehose boob, right. And long-term use of nipple shields can cause a decrease in supply.

So when we’re managing an oversupply, like that side effect is not something we’re worried about, that might actually help us. The whole time you were saying that I was just thinking, yeah, it’s like, wearing three condoms, slows it way down. Decreases that stimulation and don’t wear three condoms. That’s a bad idea.

Yeah.

Yeah. But like you said, it decreases the nipple stimulation that baby is giving us and so therefore can decrease supply. And if your baby has gone through something, you know, lots of things can happen in the first week or two. Maybe they had to be bottle fed for some reason. Maybe you were kind of out of commission for a while.

And now you’re trying to transition from bottle back to the breast. The nipple shield can help them get to the breast because they are used to that hard plastic feeling. And they’ve been trained that when they feel that a hard plastic in their mouth, that means they’re about to get food and that’s what you latch on to.

But the good news is they’re very neuroplastic and they can be retrained, but that’s one of the ways that you could use a nipple shield. Yeah. They’re the most neuroplastic humans. They have the greatest capacity for brain changes. So like nothing is permanent in a baby like that.

And added on to that, then the plastic of the nipple shield maintains its shape whereas a nipple like retracts more when baby’s not sucking. So babies who struggle to maintain their latch, don’t have to keep attempting to relatch and getting tired and frustrated. Guys, each of these issues is so complicated because like we mentioned, we want to see the shield used as a tool to get us to a solution, not as the solution itself.

Yes. So we would be remiss to not talk about things that we worry about with long-term use of nipple shields. I could honestly care less about short-term nipple shield use. I don’t get mad when I see somebody using one. I just ask more questions and I want to make sure that they’re informed and that they know what they’re doing when they go home.

You know, but I’m not mad at using a nipple shield. That usually says to me, this person needs more help right now. Something’s going on. And we’re trying to get to the breast, and this is a person that’s motivated to keep their baby on the breast. So this is somebody that I am like zoned in on where I’m like, okay, how can I help you?

And the things that I just like to inform them of when they’re using these without freaking them out or making them feel shamed in any way is just that general concept of nipple stimulation leading to milk supply. So you stimulate the nipple, you get milk supply. Anytime you are putting a barrier between the nipple and a mouth we are going to have a little bit of an interruption.

Now this is debated among professionals in the research, but for me in these situations where research is kind of like, I don’t know, I just like to lean into common sense. And it makes total sense to me that if you put a barrier between a mouth and a nipple, there is a decrease in stimulation, period.

I don’t care how thin that silicone is. There is something there and we need to take that into consideration. The reality is like, we, if we’re not pumping milk, then we’re trying to measure a subjective thing. Right? So there’s, it’s, it’s really hard then to say, does using a nipple shield lead to a decrease in supply when we can’t measure that?

We can gauge what parents say their experience was. How many babies ended up bottle feeding or formula feeding, but we can’t ever definitively say that was because of the shield or the shield caused low supply and that caused this. Yeah. And then it becomes a chicken and the egg scenario where you’re like, I don’t know, was it the shield or was it low supply to begin with?

I don’t know. Right. But I think we can say pretty definitively that using a nipple shield correlates somehow with lower supply, whether it is some independent factor that is correlating them, we don’t know. Okay. Yeah. And you know, just to kind of tack on to that is there’s a difference between a decrease in stimulation leading to a decrease in milk supply and a milk transfer issue.

So a milk transfer issue is different. That means there’s something getting in the way of the baby getting the milk from the breast and into its belly. And for a long time, nipple shields got a bad rap for giving milk transfer issues because previous nipple shields were made out of rubber or latex, and those would collapse and restrict the flow and babies would have to work really, really hard.

So we would see a lot of slow weight gain in those kiddos. But now that we use like the really thin silicone pieces, we do see less of a short-term issue with milk transfer now. And we can be pretty confident in that because we can do weighted feeds with like really high-tech scales now. And that research is cheap and easy to do.

Yeah. I think one of the things that I see as a big problem is that when we introduce something that is not self-cleaning, like a nipple, we deal with more pathogenic microbes. Right. We’re dealing with more yeast infections, more bacterial infections, just because like, it’s hard to clean that nipple shield, especially if you have to use it at every single feed.

Oh yeah, no doubt. I mean, who hasn’t picked up the nipple shield from between the couch cushions, blown it off, looked at it in the light and been like, it’s probably fine. Only one dog hair only. Well, yeah, get the dog hair off of there. Let’s do this, baby’s already screaming, like what the heck? And you know, you don’t really think about it because it’s not a pump part.

Right. But it is. Yeah. And, and it’s just like, they, it’s, it’s a hard thing to do at 3:00 AM. You know, especially like we said, you’ll lose them easily. Maybe you start out with 10 and you’re like, okay, then we’ll wash all 10 at once. And in two days you have one left. Right. Like hair ties, you know? Exactly.

That’s, I’m glad they’re cheap because good Lord. But also, I just wanted to mention, there is research that shows that when baby’s saliva mixes with breast milk, it yields hydrogen peroxide, which actually kills pathogenic bacteria on the nipple. And can you say that again? Yes. When you take breast milk and mix it with baby saliva, like direct breastfeeding scenario, it creates hydrogen peroxide, which fights pathogenic bacteria.

And the coolest part about that whole thing is that when you try to recreate that scenario with adult saliva in a Petri dish and you mix adult saliva and breast milk, it does not work. It does not make hydrogen peroxide, which means babies are magic. Wow. There’s something special about baby spit. Now I’m like, Ooh, like what, is there an enzyme?

Is there, like, what is it that’s different? Something. But again, you know, if you’re not getting the opportunity to have baby’s mouth directly on the nipple, you’re losing that opportunity to create hydrogen peroxide, which keeps the areas pH clear and what it’s supposed to be and keeps that pathogenic bacteria off of there.

So. Cool. I know. I mean, don’t get in the way of magic. That’s all I’m saying.

Oh goodness. Yeah. And encompassing all of these problems of course, is that we are increasing the stress of the parent who has to use this device to breastfeed their baby in most cases. Right. Some people use them and they’re like, woo. It hurts less. This is easy. Most people I’ve worked with who use them are like this stupid thing that I have to use.

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And they then transfer that into a judgment of like quality on themselves. And you know that they’re like not good enough because they can’t breastfeed normally and blah, blah, blah. And we don’t need that BS in our lives. Yeah. And then babies can become reliant on it too. Like I said, I don’t think they become addicted to it.

I don’t, babies don’t have addictions, but they are trained neurologically in a certain way to have the experience of something plastic in their mouth. Yeah. And it’s, it’s changeable. It’s just, it’s, it’s hard work sometimes to retrain a baby how to eat without it. Yeah. It’s just one more thing. Yeah. And that’s the last thing we need is one more thing to deal with if we don’t have to.

Right. So let’s talk quickly about how to use it. So I just want to clarify, I said, no nipple shields in the first 24 hours, and this is why. This is what I mean. Because if I have a baby that for whatever reason, can’t latch or won’t latch, I am getting the birthing parent to pump, you know, so we’re pumping.

If I’m not removing milk, I’m going to go ahead and pump. Cause we still need to stimulate. So if baby is not able to get to the breast and remove any of the claustrum, we’re pumping. We want to make sure that we’re still establishing a good supply. I’m going to be pumping and then placing the baby on the breast and seeing what happens.

And if it works and they get a couple sucks, I’m happy. I’m like great. That’s more stimulation, baby’s learning, maybe baby’s recovering. Baby is doing a lot of really important stuff in that first 24 hours. I just need to make sure those nipples and breasts are getting stimulated. That’s mostly what I’m doing that first 24 hours.

I’m not adding devices. I am trying my hardest to make sure supply is coming in and we’re giving baby plenty of opportunities to do what it can do at the breast. And it’s giving me more opportunities to see what’s going on because if it’s the first feed and you’re throwing a nipple shield on there, I’m going to look at you with my, and my eyes will cross because you haven’t even given the baby a chance to show you what they’re capable of.

It is a brand-new skill learning how to eat and root and latch and suck, swallow and breathe. Give them a minute to show you what the problem is before you throw a device in there and stress everyone out. And so that being said, that’s more of an explanation about my 24-hour thing. For those of you that were like, oh my God, Heather, what are you talking about?

But let’s say how to use it. It’s the second day of life. Baby is still not latching for any of the reasons we listed above. Engorgement, inverted nipples, weak suck, whatever. You’re still pumping at this point, because if baby is not able to remove that milk still, you need to be pumping after these attempts at the breast, with, or without a shield to ensure that this milk supply comes in and it’s being established.

If baby is losing too much weight or maybe they’re jaundice, or maybe they’re hypoglycemic and they need volume, so they need calories and they need volumes of milk. You can pump the milk and or use formula in a tube feeding through the nipple shield. This is when things start to get a little complicated.

This is where those hospital lactation consultants are like the heroes of the century, because they get you hooked up to a little tube. They get whatever milk you have and, or formula, and they get that baby at the breast because we’re still telling that baby, this is where you come for the food and we’re giving them a little bit of a handicap.

Like they’re bowling. You got to give them a little handicap in the bowling. That didn’t work, did it? I think it’s a, yeah, I think that’s more of a golf reference. Right? I don’t know. Anyway, we don’t do sports even like, even like those kinds of sports. Or cars, like what are my sports and cars references. I don’t know why we even try them.

We’re like we’re going to be relatable. We sound like aliens. Oh God. So anyway. You use the nipple shield in order to get volume into the baby and keep the baby at the breast. And the baby gets a reward for its hard work at the breast, because maybe your milk still isn’t in. So it needs to know it needs that trigger in its brain that’s like I’m at the right place.

I got the right thing and that neurologically tells them, Ooh, keep that one, keep that one and prune the other ones. This one gave us something good. So we can use the nipple shield and that way on the second day of life. Okay. So that’s how to use one on day two. Like when, when you’re in a situation. Now, when you are using these nipple shields, it’s important to realize that they also have to be fitted and sized correctly for the base of the nipple, just like a pumping flange would cause there’s different sizes.

And actually that’s one of my biggest complaints about nipple shields is not every brand offers different sizes. If they offer different sizes, it’s like here’s a 21 millimeter and a 28. And you’re like, what if I’m a 15? There’s not like inserts, like you can get for the pump flanges and stuff that I have found.

So I feel like these rarely fit well. And the other thing is, you know, people don’t realize once your baby starts sucking on the nipple shield, your nipple will swell and it will extend down into the tip sometimes. And this is a situation for people who have a baby issue. Like the baby has a weak suck, but everything’s fine with their breasts.

This wouldn’t happen with like an inverted nipple or a flat nipple because the nipple just wouldn’t stretch that far. Right. Normally we see nipples stretch all the way down baby’s throat, and that’s really far. Yeah, it’s far, but also at the tip of this nipple shield are four little holes. And if your nipple is repeatedly getting sucked down completely into those holes, you could end up with a nipple tip injury from the shield.

It looks like little blisters, right? In the shape of that thing. It’s yeah. Like a little Cloverleaf. Yeah. So just please keep in mind that if it hurts at the tip, it could be because it’s not long enough, like you might have to go up a size or something, or maybe just like nix it all together because it’s just not, it’s not worth getting a nipple injury over.

Cause that is gnarly sometimes. We just don’t need that. And also, I just want to say that there is a correct way to put these on the nipple, so you can actually use breast milk if you have it or just some clean water around the inside brim of it. And then you turn it inside out, center it over the nipple and then flip the brim down.

And the wetness that you placed on the inner brim will create a suction on your nipple and your nipple will actually begin to be pulled down into the tip on its own. Cool. Yeah. So if your nipple shield is falling off constantly, you probably just need to wet it a little bit. That sounds good. Can I talk a little bit about how to use a nipple shield when we’re dealing with like acute pain?

Yes. Cause I think that’s the second, most common reason I see it being used and it that’s usually around two weeks old, but sometimes we see it for like nipple injuries later. Right. But you know, most commonly people call me at around two weeks. They’re sobbing every time baby latches, their white knuckling a chair.

So usually what I say to them if possible is use the nipple shield, every other feeding, if that feels doable. Right. So that we don’t lose like that direct feeding. And it kinda just gives you a little bit of a break. If you have to use it every feeding, okay. But if we can do every other one, then we’re creating like equal feedback between those experiences for baby.

And it’s going to be easier to get rid of it. Yeah, good call. And you know, you’re the parent, you make the rules. You know, just because someone handed you a nipple shield and said use this doesn’t mean that like you have to use it now. It doesn’t mean you have to use it every time, you know, just do what feels right to you in that moment.

And if you’re so stressed about getting rid of it and put it on, you know, put it on and worry about, I always like to take the Scarlet O’Hara approach. I won’t worry about that now. I’ll worry about that tomorrow.

She says, in Gone With the Wind. That’s me. I just do that all the time now. And it works very well for me. So also just wanted to say, if you are using a nipple shield, please be monitoring the diapers, the diaper counts and possibly the weights, depending on the situation, the weights of the baby. Not just because of the shield, but because you’re most likely considering using a shield because we’re looking at these other things like milk transfer issues and weak sucks and things like that.

You know? So if, if you’re using a shield, just kind of watch out for that. And we have an episode on poops and pees that you are welcome to go check out. Yeah. I do want to say, I have had a lot of people ask me if a nipple shield is appropriate when they have an injury with an older baby.

And that’s actually a tricky one, right. Because if we’ve got like a bleeding nipple with a two-month-old, I’m like, all right, cool. We’ll use that for a little bit. See what we can do. But when we have like a 10-month-old or a 15-month-old, the nipple shield can very easily become a toy and it can become something where they’re like, Ooh, this is a new texture, chomp, chomp, chomp. Rip it right off.

And then that introduces like a whole new problem. Right. So. Usually I do not recommend it for that. When we have a baby at an age where they have mastered voluntary movement and they’re already like playing with your necklace and your face and stuff, when they’re nursing, like we’re going to try a different strategy.

Yeah. Good call. I didn’t even think about that honestly, but that happens. It’s a disaster is usually how it goes. Everything’s a toy at that age. Yeah. I know. Usually what I recommend for that is that we do every other feed pumped and feeding expressed milk and seeing if we can manage pain that way versus the shield. Because it’s yeah, you just don’t want your baby getting used to trying to chomp on a new texture at that nipple that already hurts.

Oh, they’re like, look at the new teether on mom’s nipple, like putting salt in the wound. Yeah. So anyway, okay. So we’ve talked about how we use them and how we don’t. Now, if we get to the point Heather, where we are using this, and we feel like we’re ready to stop using it, then what?

So you pretty much know you’re ready to stop using it if baby is latching regularly with the shield, transferring milk, having adequate diapers and weights. Everybody’s stable. Okay. So if everybody’s stable and baby is at the breast regularly, we can start to think about weaning. I do want to say that it is no longer recommended to cut the tip off of the nipple shield a little at a time. Who who, who decided that was a good idea?

Why? I don’t know. But honestly, when I first started as a lactation consultant, I thought that’s what you were supposed to do. And I actually went back and had to do my own little correction corner because I, I actually tried it once with a patient and I was like, wow, this did not work out. Like what the heck?

And I was, I felt so bad. Do a nice little wound circle on the circumference of that nipple. Right. So that can create a nipple injury, obviously. So don’t do that because of the rubbing. So it’s going to like come out and be fine. But when it sucks back in, it’s going to rub that entire outer ring that you have just created.

And it’s like a rough edge on the silicone. Painful. Yeah. That’s dumb. It’s dumb. And I recommended it in the beginning and I’m sorry for it, but I’m here now. There should always be room for growth and learning. I’m not perfect. I’ll be the first to admit it. I get confused about gram positive and negative bacteria.

It’s okay. I clearly either wasn’t listening enough to correct you or wasn’t thinking enough to notice that that was wrong. Yeah, sure that’s not the only mistake we’ve made. So once again, if you ever catch one on the episode, just send us a quickie little email and we’ll correct it. Yeah. We don’t have any shame.

Just tell us, you know, we’re just all doing the best we can. All right. So weaning. Let’s discuss. So here’s what you’re going to do first, when you’re ready to wean, I would recommend starting it on a weekend. Don’t start it in the middle of a busy work week. Okay. We need you in a headspace to learn new things.

For example, would you like to, to learn a brand-new skill, like calculus in the middle of your busy work week? Or would you rather take a weekend to like have a cup of coffee? You know, sit down, think about it, you know, mull it over, get in the good space and then start. So that’s what we’re going for here.

For a new skill for you and baby, don’t start it at night, started in the morning when you have three days to really focus on it, at least. Okay. Now we are going to start on the bare breast every single time. Okay. And everyone’s going to be like, oh my God, what? That’s like yeah, because what happened.

Just try it. Cause what happens if you put baby on and they just latch and you’re like, oh right. Funny story. I thought I had used a nipple shield and this kid actually has grown a lot in the past two months and I just never checked in because we get stuck in these routines. So babies change all the time, throw that kid on the boob if they suck, great.

If they don’t and they get upset, just put the shield on. Yeah. We already know how to do that. We’ve mastered that skill and, and this is one of the reasons we’re like do this on a weekend where you can like cultivate a little bit of patience for this, because most of the time baby is going to be a little bit fussy. You are going to have to go back and forth from the shield.

It’s okay. Yeah. And then make sure that you congratulate yourself and baby on any good things that happen. Even if they’re like fussing, but sort of latched, just be like, Hey baby, this is wonderful. I’m so happy you’re latching. Thank you so much. Okay. We can do the shield now. Cause you’re getting upset. Yeah. Like new things are hard, but it’s good that we try new things.

Yeah. So, and, and like always, you know, we always encourage you to do this when you’re feeding your baby and having a hard time is that you stay as calm as you can because they’re very sensitive to our emotions. And of course associate our positive emotions with positive experiences and negative emotions with negative experiences.

Yeah. And speaking of positive experiences, you can actually get ahead of this a little bit by stimulating your nipples prior to latching to bring a let down on. So that way, baby doesn’t have to wait for milk. So if milk is already there and, and you put baby on the bare breast, they’re going to be like, oh, what, thanks.

Totally. So reminder of ways we can do that. You can pump a little bit; you can hook one of the haakaa on for a few minutes beforehand. You can just do a little bit of breast massage and like a minute of hand expression, you know, that’s, it’s, it’s pretty easy. Or even just sometimes some gentle nipple rolling or stretching.

I mean, don’t hurt yourself, but Lord, I mean, you can just stretch your nipple a little. You just have to perk those little guys up. This little guys, little guys. So if you do this consistently, baby will eventually be like, oh, I guess I can just suck on this regular nipple and all will be well. Cool. And don’t put yourself on a timeline.

So we said three days, what we meant was give yourself at least three days to practice this, but for complete removal of the shield, that depends on you and baby. It depends on what you have going on. It depends on what kind of nipples you have and what oral restrictions baby has maybe. And you know, who else is helping you sometimes. You’re fine.

Like it might take one try. It might take you two months, but it’s worth it because it’s something that you and baby are working on together. Think of it as like your first project together. Baby is helping you with this. This is a cool thing. You are learning something brand new together, and that’s beautiful.

I think that’s a nice way of thinking about it. And you know what, like, like we said, this is not all or nothing. You can always go back to it. It’s always going to be there, you know, put it in a safe little place. It’s fine. Yeah, it is fine. You’re fine. You’re doing a good job. Most people that are trying to wean off of a nipple shield have been through hell and back with lactation.

I just want to acknowledge that. So if you’re crying right now, thinking about what a hard time you’ve already had, I get it. I mean, this is why my consults take usually no shorter than an hour, because it’s just, we have stuff to talk about. Those feel like the quick ones these days. I know. I mean, people have been through it, man.

Yeah. We get to the end of an hour and I’m like, so now I know how you got here. Can you tell me your problem? Yeah. Yeah. And that’s part of it though, right? I mean, trying to reverse engineer, what happened in the beginning and get you to where you want to be in your goals. And if your goal is to use a nipple shield until the end of time, go you, you do it.

If that’s working for you a hundred percent, go for it. You know, we’ve informed you of what it is, things to look out for. Now you know. And now you can call yourself informed, make that choice, pat yourself on the back, sleep tight. Yeah. I mean, I think my biggest issues around this are really focused solely on the introduction of nipple shields, because you should essentially have informed consent.

That sounds like this whole episode, when you start using one, if you’re given one by a healthcare provider. Yeah. If there was only time, right. You should be informed of the risks of using one, the benefits of using one, and it should be framed as a short-term tool that you have the option of getting away from and then, you should be given the tools then to do that.

Yeah. And the phone numbers of people to call, because this is all complicated stuff. Like that’s why we’re specialists. And there are so many clients I see that they’re, they have like a six-month-old using a nipple shield and I’m like, so why are you using it? And they’re like, I don’t know. I can’t remember.

I have no idea. They just gave it to me in the hospital. And I’m like, okay, great. So we just don’t have to use it then. Right. And they’re like, what? I can’t remember the reason it’s like, when you let a dog off of its leash at the park and they don’t go anywhere and they look at you cause it’s like, am I free?

And the minute they realize they’re free, they take off. But you know, like ideally this, every time would look like what, one of my dear friends and our patrons, Rebecca went through where it was a couple of, they, I don’t know if she was still in the hospital after baby was born, but I think it was day two or something.

And, you know, we were talking about it and baby was having a little bit of trouble latching and it hurt and the nurses offered the nipple shield and we just texted about it a little bit. And I was like, all right, here’s the problems with the shield. Yes it will help with your pain most likely. And if you use it, just think of it as a short-term tool. It’s a band-aid and stop using it as soon as you can.

Maybe that’s the feed after you start using it, maybe it’s in two days. And that’s what it was. She used it like five or six times. Yeah. Guys. All right. Well, I think we need to wrap up and we needed to give some awards because, oh yeah. I have a lot of people to thank also still. We do, we have so many people to thank.

We have really been working so hard for you guys. We are putting our heart and soul into this podcast. All of our free time. We have a new website coming. We got our photo shoot done. In case you haven’t seen the pictures yet, they will be up soon. And yeah, thanks to you all. We feel like we’re actually making a difference, which is the greatest blessing that anyone could ever ask for in a career.

So thank you so much.

Let’s take a quick break to thank our sponsor Aeroflow. Aeroflow is your one-stop shop to get the most popular breast pumps and accessories through your insurance. So don’t let your insurance go to waste. Why don’t you let Aeroflow do all the dirty work for you? You never have to call your insurance when you use Aeroflow and they remind you when you’re eligible for free replacement parts.

Yep. So when you’re tired in your postpartum period, and you’re wondering why your pump isn’t working as well, you might get a text that says, did you know you need replacement parts? And you say, I did not know that. Right? You push a button and boom; they show up at your door. Thanks, Aeroflow. Thank you so much.

Go ahead and check out the link to Aeroflow in our show notes and order your pump through them.

So first let’s give our award in the alcove, even though only you are in the alcove today. Yeah. Let’s do it. I’ll let you do it because you tell us where you are though. I am in a, well, we call it the phone booth, but it’s kind of just a closet and I’m in a coworking space in Elkins, West Virginia called the Common Door that I have a membership to because they have the fast internet and they don’t have my kids.

And it’s a lovely space to be at. So I’m very thankful for it. Okay. So I have been saving this award for it’s maybe been like two months now because I just really wanted to put it in this episode. Our award today goes to Christina Fryer, who is a patron of ours. And girlfriend joined right before we had a live Q and A and came to us with some nipple shield problems.

And I’m going to read her post from two days after our live Q and A. Okay. So she said I’ve been using a breast shield since leaving the hospital. No one, not the OB or pediatrician told us to ever try and stop. After one zoom with Maureen and Heather, they guided me to stop using it and help set up my expectations for how to wean off.

Literally two days later and we haven’t used the shield in 24 hours, and then she put a little mind blown emoji next to that. Hell yeah. Christina, that’s all you girl. I mean, honestly, we got to hang out with you for an hour and just chill with a new friend and talk about things that we love talking about. You’re the one that hung up and put in all the work.

So pat yourself on the back for that. Yeah, and that was awesome. And I really hope that you guys at home are hearing that and you’re like, wait a second. I can, that I can do that. Yes, you can. Yes, you can. You deserve it. So Christina, I’m giving her the Kick It To The Curb Award. Oh, I love that. Good fucking job being persistent and patient through that process.

Yeah, absolutely. Very good job, Christina. We’re super proud of you and we can’t wait to see you at our next live Q and A. Okay. So before we go today, I have to thank a few people because we put out a call for some fresh reviews for our website makeover that I didn’t just pull from our apple podcast reviews, which by the way are lovely and we absolutely love, and I read them all.

Okay. So people who pulled through for me were Alex Cordial, Andy Ward, Jessica Marie, Elizabeth Mary, Sarah Kanner. Someone with the Instagram handle, the Mrs. Siefried, who I think might be one of our patrons now. Megan Rose, Susan Morgan, Natalie Colombe, Marley Brooke and Jen Livengood. Thank all of you for going to all of our different platforms, leaving different reviews so we can have some fresh stuff up on our new, fresh website. Yeah. Thank you guys so much. And if you haven’t checked it out, it’s MilkMinutePodcast.com. Okay. Do you want to guide us out today, Heather?

Thank you all so much for listening to another episode of The Milk Minute Podcast and educating yourself on breastfeeding. The way we change this big system that isn’t set up for breastfeeding parents is by educating ourselves and sharing with our children and our friends. Now, if you found some value in the episode we produced for you this week, please go to Patreon.com/MilkMinutePodcast and show us your support with a small donation, which grants you access to cool members only stuff.

Thanks for joining us today. And we’ll see you next time. Bye. Goodbye.

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