Should you use a nipple shield to solve your latch pain problems?

Have you been having nipple pain, and are wondering if a nipple shield is the right choice for you? If so, you've come to the right place. In this blog, I'll tell you what need to know before making the decision about whether or not to use a nipple shield.

TLDR ANSWER: Nipple shields almost always make the quality of the latch worse, even if they end latch pain. The big risk is that you get stuck using it and they are a pain. If you have stretchy breast tissue, then they don't stay on very well, and that poses some other challenges.

A nipple shield is just a tool that can be used to help make feeding better in the right situation, but just like you want to don't want to use a hammer on a screw, you want to make sure that a nipple shield is the right choice too.  You could make the screw go in with a hammer, but it also might bend and split the wood in the process, because it's not really the right tool to use.

A nipple shield is a tool that's used for 3 reasons.
1. A baby can't get the initial latch onto the breast.
This is the most common reason nipple shields are given out, and generally why they are given out at the hospital.

2. A baby has weak muscles in the mouth, and the nipple shield makes it easier for them to stay latched onto the breast.

3. Breastfeeding hurts so much that your nipples are getting damaged or you are going to stop doing something you otherwise want to do.

Since we are here today to talk about nipple pain, I'm going to focus on number 3.  If you are deciding to use a nipple shield because your nipples are physically damaged, that makes a ton of sense as a way to stop the damage from getting worse or to help your nipples heal.

When you are using a nipple shield to help reduce latch pain, the most important thing you need to do is to address why you were getting the pain in the first place, and for lots of you, it may be happening because of how you were taught to latch. If you are stroking your nipple down your baby's mouth, and they are chewing your nipple into their mouth, it's the force from the bite that is causing your damage and pain.

When you use a nipple shield, that can spread out the force a bit, but stop the damage from happening. It's really hard for a baby to get a deep latch on a nipple shield because they stick out farther from your nipple and most babies end up chewing them into their mouth. You end up reinforcing that same behavior that caused the pain in the first place, and it creates a loop that you can’t really get out of very easily.

Here is the good news: getting your baby to open wide before your nipple goes into their mouth is a magical fix for nipple pain, even when there is some damage, even if you have been told your baby has a tongue tie. If latching hurts you, it's probably because the approach to latching you are using for your baby isn't working for you guys, and a different approach may make all the difference in the world, and then you won't need the nipple shield anymore anyway.

If you are giving me the side-eye about this and still plan on using a nipple shield, I do not blame you. I know how much it hurts when latching isn't working. Here is what you need to know so it's easier to break out of the nipple shield cycle when it's time.

You want one that is soft. 
Some nipple shields are softer than others, and you want one that is soft. The nipple shield provides a different sensory input to your baby's mouth, and if they get conditioned for the firm feeling, it can make it harder for their brain to notice a softer feel.

The Medela nipple shields are really firm. I'd avoid those. Some widely available softer ones that I use are Lansinoh, PurifyYou and Mamivac. These are available on Amazon, and this is definitely not an extensive list. The next thing you need to know is that nipple shields come in sizes.

You need it to fit your body.
You want to measure your nipples to make sure you get close to the right fit. You can do that in exactly the same way you would measure your nipples for a pump flange, instead of staying the same size or going down, you probably want to go up 1-2 mm. It will stay on a bit better.

The average nipple is 17-19 mm, so your best fit with the nipple shield is probably a 19-21. Fitting these things is an art, not a science, so you'll have to experiment to get your goldilocks fit. The smaller they are, the shorter they are, and the easier it's going to be for your baby to get more of the nipple shield - and your breast - in their mouth.

Put it on by flipping it inside out first.
When you are putting a nipple shield on, you want to make sure you flip it back before putting it on. That will help to get more of your nipple into the shield, and it will help them stay on better. You can try adding a tiny bit of breastmilk or water to the rim of the nipple shield to help it stay but the truth is that there are just some breast tissues where they simply don't stay very well.

Pay attention to how you latch. 
And finally, remember that nipple shields can reinforce the same latching problems that caused the damage in the first place, you just may not realize it because it doesn't hurt. So, you really really want to pay attention to your mechanics when latching and make sure your baby opens wide, and comes up and over your nipple when latching.