Need some help - urgent-ish - flat nipples, nipple shield question

[Schmickers]

Hi guys,

This is a question on behalf of a client of ours who is having some troubles feeding her 3 day old. She has quite flat nipples, and the baby will not attach well, although when she used a nipple shield, he attaches very well. The main problem with that is that she is experiencing significantly more pain feeding with the shield than without. She has tried different feeding positions, shaping the nipple and areola (he will attach and take 5-6 good sucks if she shapes, but after that will lose his attachment again).

At this stage, she is preparing to use the shield in the short term and hoping that once he gets a bit older and bit more awake he will have enough energy to draw her nipple and areola out more, but I am wondering what the current professional opinion is about nipple shaping devices, like the Avent niplette or the medela nipple shield/shaping thingies? Do they work? Are they recommended? Or do they cause more problems than they solve?

And any other suggestions for flat nipples?

[Shellbelle]

Only thing I can maybe suggest is expressing with a pump a few minutes before feeding. Will make the breasts a bit softer to attach and also draws the nipple out.

[Indadhanu]

I was going to say the same thing as Shellbelle, using a pump might help to draw and shape the nipple before feeding?

No idea about the devices though

[alioops]

When Em was little she couldn't attach without the sheilds, they did help for a little while, until we found out why she wasn't gaining weight properly. I have never used one of those nipple shapers, but from the looks of it, it should suck the nipple like expressing, but I wonder if the pipette would have enough suction. If your client has a breast pump i would suggest getting her to draw the nipple out with the breast pump rather than buying another piece of baby apparatus

[fionas]

The LC in the hospital told me I had flat nipples too and her advice was to try feeding with nipple shield first, then express then use the expressed milk to top her up. Sounds great in theory but that took 1.5 - 2 hours per feed, every feed. So I wouldn't recommend that course of action!

Has her milk come in yet? It could be that the flat nipple issue is being exacerbated by the shape of her breast if it's getting hard/fullish just before her milk comes in.

So yes, I second the try to express a little before attachment and if not, use the nipple shield in the short-term if the attachment seems better with that. Or put it another way, do whatever works and don't worry too much about whether there will be difficulties getting rid of the shield down the track. Cross that bridge later.

[MantaRay]

I was told that DS1 wasn't able to attach due to flat nipples. We finally got him attached using nipple shields when my milk came in. Then we discovered he had a tongue-tie and that was the real reason he couldn't attach. We had it snipped and he was then able to attach without the shields. When DS2 was born, I was told I had great nipples for bfing (despite having previously been told I'd probably never be able to bf without shields So the point of my rambling is to suggest that you check for tongue-tie as well. Do the nipples look really flat? Do they come out at all when the baby attaches?

Also, I did find it painful feeding with the shields, as DS had to suck harder. But then the nipples are pretty sensitive in the early days so it can hurt without the shields too. Usually a baby can attach more easily when it's mouth is a little bigger, so if she does need to use shields now, it most likely will only be for the short term, maybe just 4 weeks or so. But it is important to keep trying to attach without them. And that might get easier when the supply settles down too. Before your milk comes in it can be hard. Then it gets worse if you are engorged. So once that initial engorgement goes, she hopefully will have better luck.

for your client. I know how hard it is, I hope it works out for her.

[Barb Glare]

Hi,
Nipple shields can be a useful tool in the short term to help a baby attach to the breast. Usually flat (ish) nipples pose no problem for the baby. They "imprint" their mother's nipple - that's why ideally we hope for an unmedicated birth, early skin to skin and no interruption for mother and baby while they get their first feed underway somewhere within the first hour. I have heard widely differing professional opinions of "flat" and even "inverted". Sometimes, when breastfeeding does not go well, and baby can't get onto the breast, then nippleshields can be a very helpful little device. Research by Paula Meier even shows that prem and near term babies transfer more milk via a shield. The first rule is always "feed the baby" and if a nippleshield can help that feed to be at the breast, then that is preferable to any other alternatives (ie cup, syringe or bottlefeeding)
Is the nipple shield the right size for the mum? I have seen mums whose nipple (although flat to begin with) is drawn into the shield and actually presses out through the little holes in the shield (ouch) Is it centred over the nipple? Sometimes you feel like you need to be an octopus to hold the thing in place while feeding. Sometimes wetting the shield with milk or water helps it stick. Has the mother's milk come in? Many mothers find it painful before the milk comes in. If on the other hand, her milk is in, and she is very full, expressing a little milk by hand or with a hand pump before she attaches (with or without the shield) might be helpful. Any evidence of tongue tie?
Lots of skin to skin with mother and baby will enhance attachement. Have you seen the latest "Baby led attachement video clips? (some-one will pop in with the URL I'm sure)