Nipple Shields: Yay or Nay?

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Melissa Portunato MPH, IBCLC, RLC

Are your nipples sore from nursing your newborn? Are you thinking of purchasing a nipple shield to prepare for your breastfeeding journey? Wait! Don’t grab that nipple shield just yet! Temporary use of a nipple shield combined with proper guidance can salvage a breastfeeding relationship at times, but nipples shields can be widely misused too! Read on to find the answers to everything you need to know about nipple shields. 

Do I really need a nipple shield? 
Far too often, nipple shields are used to mask breastfeeding issues without getting to the root cause.Truth is, most moms do not need them at all. Nipple shields essentially create a barrier between you and your baby. They are infamous for low weight gain, clogged ducts, low milk supply and a ton of other breastfeeding issues, even Mastitis. Some newer research tells us temporary use of nipple shields could possibly salvage a breastfeeding relationship if it’s combined with skilled lactation support early on. 

What are some instances a nursing mom might benefit from the temporary use of a nipple shield?
It’s surprising for most to learn flat or inverted nipples begin to naturally draw out with breastfeeding. Even with inverted nipples that don’t protrude with stimulation, nursing or pumping will draw them out and a nipple shield is not even needed. There may be instances, where the nipple does not protrude and a nipple shield can be beneficial. 

Other special circumstances include premature babies (born earlier than 36 weeks) and transitioning from bottle to breast. The supervised use of a nipple shield has been linked to temporarily improving or prolonging the breastfeeding relationship in some studies. 

How do I use a nipple shield?
If you decide to use a nipple shield, make sure it’s the right size and made of thin silicone material. The shield should fit securely over the nipple and areola. When a baby is latched and actively nursing at the breast there should be visible movement on and around the breast. Also, there should be breastmilk on the tip of the shield. These are all indicators the nipple shield placement is correct. Working closely with a local International Board Certified Lactation Consultant, IBCLC is critical to ensure your baby is nutritively sucking at the breast and transferring adequate milk to grow and thrive. 

Weaning off the shield
Nipple shields are intended for temporary use which means the goal should always be to wean off them. Switch and bait can be an effective technique when weaning a baby off a nipple shield. Start nursing with the shield, slip it off and then quickly re- latch baby directly at the breast. This approach can take patience and practice. Start feeding sessions skin to skin and offer the breast at early feeding cues. Crying is a late sign of hunger and a “hangry” baby will be much harder to latch. 

Protect your milk supply if your baby is not latching by dual pumping using a Spectra Baby USA hospital strength pump. In addition, introducing a supplemental nursing system can aid at keeping baby nursing at the breast while trying to wean off a nipple shield. 

Getting skilled lactation support early can prevent the use of nipple shields all together! Nipple shields are not intended for long-term use and should be approached with caution. If you decide to use a nipple shield work closely with a local International Board Certified Lactation Consultant, IBCLC who has experience with using niplpe shields. 

Do you have breastfeeding questions? Schedule a free Spectra Baby USA virtual consultation with one of our experts to help you on your breastfeeding journey! 

We are here for you and we support you! 

Sources:

Chertok, I. Reexamination of ultra-thin nipple shield use, infant growth and maternal satisfaction. J Clin Nurs 2009;18(21):2949-2955.

Meier, P. et al. Nipple shields for preterm infants: effect on milk transfer and duration of breastfeeding. J Hum Lact 2000; 16(2):106-114.

Kronborg H, Foverskov E, Nilsson I, Maastrup R. Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding?. Matern Child Nutr. 2017;13(1):e12251. doi:10.1111/mcn.12251

Breastfeeding and Pregnancy

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mom on couch with breast pump

Melissa Portunato MPH, IBCLC, RLC

Did you just find out you’re expecting a new baby and you’re currently breastfeeding? So many emotions can begin to flood your mind when you start to process that a new little one will be joining your family in just a few short months…excitement, joy, anxiety and uncertainty. If you’re pregnant and breastfeeding, you could be asking yourself questions like “Will I need to stop breastfeeding since I’m pregnant? Can I harm my unborn baby by continuing to breastfeed throughout my pregnancy?” Take a deep breath! We got you covered! Read on to get evidence based answers to everything pregnancy and breastfeeding. 

First things first, is it safe?
Nipple stimulation triggers the release of the oxytocin hormone which can trigger contractions. Research tells us less oxytocin is released when a woman is pregnant making it generally safe for a healthy mom to continue nursing while pregnant but not always. If you are exclusively pumping, remember that is breastfeeding! We recommend scheduling a prenatal exam as soon as possible to thoroughly discuss your personal situation with your doctor. If you are considered a “high risk” pregnancy you may be advised to discontinue breastfeeding to ensure your pregnancy will be safe and smooth. The current data reflects breastfeeding and healthy term births are not only compatible but biologically normal.

Changes in Milk Supply and Composition
Hormonal changes in pregnancy can cause milk supply dips and fluctuations, as well as, increased nipple tenderness. Your nursling might want to breastfeed more frequently or become less interested. Supply and demand, won’t typically hold up even if breastfeeding has been increased. Some mothers do not experience a decrease in milk supply at all while others do. Everyone is different. Milk composition will begin to transition into colostrum during your third trimester. Increased sodium levels in breastmilk can change the taste of your breastmilk and this combined with less milk, could lead to natural weaning yet; some kiddos do not mind at all and continue to nurse. The AAP recommends breast milk as the primary source of food for the first year. Closely monitor your baby’s breastfeeding behavior at the breast, weight gain and diaper output to ensure they are growing and thriving. 

Tandem Nursing
Colostrum will be produced for your newborn during the first few days postpartum even if you have continued to breastfeed an older child throughout your pregnancy. Since colostrum is packed with immune properties and prepares the newborn gut for mature milk you want to make sure you are giving your newborn priority at the breast during the early days after delivery. Nursing both of your babies at the same time, called tandem nursing, can be a way to offer emotional security and extra attention to the sibling. Tandem nursing can also help lessen engorgement and create an adequate milk supply. If you decide to wean your older baby, gradual weaning is always best. Avoid being seen in your typical nursing areas, don’t offer the breast but don’t refuse either. Redirecting behavior when asked to nurse can help the weaning process too, like offering a snack or a favorite toy. 

Pumping To Induce Labor and Colostrum Harvesting 
If you haven’t been breastfeeding since the beginning of your pregnancy it’s not recommended to start now unless you are full term (over 38 weeks) and under the care of your medical practitioner. Pumping or hand expressing can be an effective way to kick start labor! If your doctor approves you can start with hand expression or pumping with your Spectra Baby USA breast pump for 10-15 minutes on a low 38 cycle and low suction strength, just a few times a day. Some mothers will even start to see some drops of precious colostrum. You can use sterile syringes to collect, store and freeze colostrum. This can be even extra important if you already know you will be separated from your baby after delivery. Always check with your doctor first when using pumping to induce labor. 

If you desire to continue to breastfeed while pregnant, you are not alone. Breastmilk continues to have benefits for your older child and many mothers safely breastfeed their older babies while pregnant. Work closely with your health care practitioner and surround yourself with support to ensure breastfeeding can continue safely. Spectra baby USA is here for you and we support your decision to breastfeed while pregnant. Schedule a prenatal consult with us and we can help you reach your personal breastfeeding goals. 

Sources:

Amico, J., and Finley, B., Breast stimulation in cycling women, pregnant women and a woman with induced lactation: pattern of release of oxytocin, prolactin and luteinizing hormone. Clinical Endocrinology, 1986 25:97-106.

Journal of Nursing Research, 20 (1) p 74-80. doi: 10.1097/JNR.0b013e31824777c1

Mohrbacher (2010) Breastfeeding Answers Made Simple, Hale Publishing, ISBN-10: 0984503900

Flower H. (2016) Breastfeeding during pregnancy and tandem nursing: is it safe? Recent research, Breastfeeding Today, 11 April 2016

Philippa Pearson-Glaze, Expressing Colostrum Antenatally, Breastfeeding Support, 24 August 2019, https://breastfeeding.support/expressing-colostrum-antenatally/ (accessed 9 September 2020).

 

HELP! My period is back! WHAT NOW?

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Jacque Ordner BSN, RN, IBCLC 

If you’re nursing or pumping for your little one, it can be months before your period returns.  Many moms consider this a bonus of breastfeeding!  However, every mother is different and that means some moms can experience the return of ovulation and their period just a few short months (or sooner) after delivery.  Maybe you’ve heard of the dreaded supply dip that commonly occurs with the return of menstruation.  Fear not! Our tips can help you adjust and adapt with hormonal changes and their effects on your supply.  

Tip #1. Don’t assume you can’t get pregnant before your period returns! Current evidence tells us that fertility returns in stages, and this means a postpartum mother can ovulate well before her period has returned.  For moms not looking to become pregnant just yet, it’s important to take necessary precautions.  Non-hormonal types of birth control are the least disruptive to milk supply, so talk with your IBCLC and your doctor to determine which option is best for you.   

Tip #2 Keep calm and nurse or pump on! A period related supply dip might be enough to keep you up at night, but the best thing you can do is keep nursing or pumping frequently! Some babies will nurse less enthusiastically during this time.  This could be due to subtle changes in milk flavor.  Breastmilk becomes a bit saltier and less sweet during mom’s period.  If your baby is nursing less, it’s important to pump in order to provide adequate stimulation and drainage of the breasts.  This helps safeguard against the dip in supply becoming permanent.  If baby seems dissatisfied with the flow, try switching back and forth between breasts multiple times during a nursing session.  This triggers multiple let-downs and can help boost supply! Pumping moms often get discouraged during this monthly dip and will shut the pump off early or skip sessions altogether.  Avoid this pitfall!  Any reduction in stimulation or milk removal can lead to milk supply decrease.  Keep pumping on your normal schedule even if the milk stops flowing earlier than usual and even if you’re getting less than your typical output.  Consider adding in a power pumping session or even mini pumping sessions to help your supply bounce back once your period is over. 

Tip #3 Address nipple tenderness. It can be shocking to experience new nipple tenderness when you were previously nursing and pumping comfortably.  This new pain can lead to reduced pumping and nursing. Nipple soreness is commonly associated with hormone changes once a mom’s cycle returns, but it doesn’t have to be a deal breaker. Consider trying new nursing positions like koala or laid back.  If nursing is too painful, consider pumping every other feeding to provide some relief.  If pumping is painful, a temporary change in flange size might help.  Some moms find pumping with a larger size to be more comfortable during this time of their cycle. Lowering the vacuum can help too!  If you haven’t tried a slower cycle like cycle 38 on your S1 or S2, we highly recommend it! Don’t forget to use hands on pumping techniques to improve the effectiveness of your pump sessions. Hydrogel pads are also super soothing and can get you through until the temporary tenderness subsides. 

Tip #4 Nourish yourself well. Eating well and staying hydrated are keys to good health in any situation, but even more so for lactating mothers during their period! Iron is an important component of red blood cells.  Choosing iron-rich foods can help replace iron lost during your period.  Pairing those iron-rich foods with foods rich in vitamin-C for will further enhance absorption. Wash down those iron and vitamin-C rich foods with at least 3.8 liters of water as recommended by The Institute of Medicine (USDA) for lactating women. Consuming adequate fluids not only supports milk making, but can also help relieve symptoms of bloating and constipation often associated with menstruation. Concerned about a dip in supply?  Talk with your doctor about adding in a calcium/magnesium supplement starting at the time of ovulation and continuing through the first few days of your period.  

Are you experiencing a dip in supply?  Nipple tenderness got you down?  We can help! Schedule your free consultation with one of our International Board Certified Lactation Consultants HERE.  You can also reach us by emailing ibclc@spectrababyusa.com  We’re here for you!!! 

References 

Bonyata, K. (2020, April 08). Natural treatments for nursing moms • KellyMom.com. Retrieved December 04, 2020, from https://kellymom.com/bf/can-i-breastfeed/herbs/natural-treatments/ 

Dullo, P., & Vedi, N. (2008). Changes in serum calcium, magnesium and inorganic phosphorus levels during different phases of the menstrual cycle. Journal of Human Reproductive Sciences, 1(2), 77. doi:10.4103/0974-1208.44115 

Hartmann, P. E., & Prosser, C. G. (1982). Acute changes in the composition of milk during the ovulatory menstrual cycle in lactating women. The Journal of Physiology, 324(1), 21-30. doi:10.1113/jphysiol.1982.sp014098 

Jackson, E., & Glasier, A. (2011). Return of Ovulation and Menses in Postpartum Nonlactating Women. Obstetrics & Gynecology, 117(3), 657-662. doi:10.1097/aog.0b013e31820ce18c 

Read “Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate” at NAP.edu. (n.d.). Retrieved December 04, 2020, from https://www.nap.edu/read/10925/chapter/1 

 

 

5 Breastfeeding Myths Exposed

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Melissa Portunato MPH, IBCLC RLC

It can be frustrating for parents when they get conflicting breastfeeding advice from nurses, doctors, family members, friends and….shriek! Yes, even lactation consultants! With so much information swarming around the internet, it can be difficult to navigate through it all and get to the hard core truth. We’re here to help! Read on as we bust through a few of the most common breastfeeding myths! 

#1 Breastfeeding Hurts!
Let’s be real. Your nipples are not used to being stretched, yanked and pulled 24/7, especially if this is your first rodeo. Soreness is normal in the beginning but pain, bleeding, scabbing though common is not normal. Good news is that tender skin on your nipple and areola is intended to be stretched. Soreness should subside within the early postpartum weeks. Work with a skilled IBCLC, to assess baby’s oral function and latch – which typically are the main causes of pain. Monitor baby’s soiled diapers every day. Your newborn baby should have at least 6-8 wet diapers and 3-4 stools every day (stool should be the size of a quarter or more). Check flange sizing if you’re pumping! Lubricating the inside of the flange with a drop of olive oil can help with discomfort and create a better seal. Lowering vacuum suction too! Don’t push through the pain, get support! Breastfeeding shouldn’t hurt. 

#2 I’m breastfeeding, I can’t eat dairy.
Not true! There’s no “breastfeeding diet” and no foods that are contraindicated while breastfeeding and this includes dairy. And though cow’s milk protein allergy is the most common allergy in babies it’s not as common as families have been led to believe. Most fussiness in newborns is normal behavior and not related to diet at all. Some telltale signs your baby might have an allergy to cow’s protein can be inconsolable crying for long periods of time, rashes, stuffy nose, blood, mucus, or froth in the stool, just to name a few. Connect with your pediatrician if you suspect your baby may have an allergy. If you do need to remove dairy from your diet simply avoiding the obvious culprits (milk, cheese, etc.) may be enough and your baby may still be able to tolerate small amounts. It can take up to 21 days to completely eliminate traces in your body. Allergies are almost always temporary and your baby’s gut will adapt and mature as they get older. Unless you, yourself are allergic to dairy, there’s no reason to avoid it. 

#3 Breastfeeding only has benefits for the first 6 months.
All breastfeeding experts recommend breastfeeding for the first 6 months but WAIT! It doesn’t stop there. The World Health Organization recommends breastfeeding for the first two years or longer, until mother and baby desire. The benefits of breastfeeding continue way past baby’s first birthday! Breastmilk continues to provide immunological properties and it actually increases in concentration in the second year. Breast milk provides treatment and prevention of many childhood diseases. In addition, breastfeeding provides major mental and social development for your growing child, with research linking breastfeeding past infancy to a more independent child later on. Breastfeeding past the one year mark is developmentally normal and your breastmilk continues to have benefits for your growing toddler. 

#4 Most moms don’t make enough breastmilk for their babies. 
If you are exclusively nursing at the breast you won’t ever know exactly how much milk you are making. Your baby’s diaper output and weight gain will be your gauge. If you are pumping, it’s never really an indicator of your supply; it really just tells us how much milk you can pump. So what do we know? On average a baby that is 1-6 months old will intake on average 25 oz per day which is about 2-3 ounces of breastmilk every 2-3 hours. This is how much milk should be produced to keep up with your baby’s intake. Truth is most mothers can make enough milk for their babies when off to the right start. This includes breastfeeding within the first hour, rooming in and supportive lactation assistance. There are some reasons moms won’t make enough milk. These include pre existing hormonal conditions like PCOS, thyroid dysfunction; and diabetes can be culprits. As well as breast surgeries or trauma to the breast can also affect how much milk a mother can make for her baby. But we never truly know how much milk will be made until baby is here! Every mother and baby dyad is different. 

#5 I can’t breastfeed if I’m sick.
Not only is it OK to breastfeed if you’re sick, but it’s encouraged! Whether it be a stomach bug, cough and cold, or the flu your breastmilk will contain antibodies to protect your baby from getting sick. Especially now, during the global pandemic, breastfeeding while sick is even more critical to protect babies from contracting Covid19. Mothers with Covid19 should be encouraged to nurse their babies directly at the breast with a face covering (if possible) or if too sick to nurse, pump their milk and have a well person bottle feed breast milk. Rebecca Powell, a human milk immunologist at New York’s Icahn School of Medicine at Mount Sinai has discovered 80% of Covid19 survivors tested had coronavirus antibodies in their breastmilk. These discoveries are not only proof breastmilk keeps babies healthy but in addition may provide insight to future treatments in combating the coronavirus. 

We hope this blog post helped boost your confidence, bring awareness and increase your breastfeeding knowledge. Be vigilant and watch out for booby traps! Are you wondering if the advice you heard is true or a myth? Our Spectra baby USA lactation consultants are ready to provide evidence based information so that you can make the best decision for the health of your family. Email us at IBCLC@spectrababyusa.com or schedule a Spectra baby USA complimentary consultation with us today! 

Congratulations on your breastfeeding journey! 

Sources:

Daniel Munblit, Michael R. Perkin, Debra J. Palmer, Katie J. Allen, Robert J. Boyle. Assessment of Evidence About Common Infant Symptoms and Cow’s Milk Allergy. JAMA Pediatrics, 2020; DOI: 10.1001/jamapediatrics.2020.0153

Duazo, P., Avila, J., & Kuzawa, C. W. (2010). Breastfeeding and later psychosocial development in the Philippines. American journal of human biology : the official journal of the Human Biology Council, 22(6), 725–730. https://doi.org/10.1002/ajhb.21073

Cregan MD, Mitoulas LR, Hartmann PE. Milk prolactin, feed volume and duration between feeds in women breastfeeding their full-term infants over a 24 h period. Exp Physiol. 2002 Mar;87(2):207-14.

Alisa Fox, Jessica Marino, Fatima Amanat, Florian Krammer, Jennifer Hahn-Holbrook, Susan Zolla-Pazner, Rebecca L Powell. Evidence of a significant secretory-IgA-dominant SARS-CoV-2 immune response in human milk following recovery from COVID-19; medRxiv 2020.05.04.20089995; doi: https://doi.org/10.1101/2020.05.04.20089995