Effect of nipple shield use on milk removal: a mechanistic study

Abstract

Background Concerns about reduced milk transfer with nipple shield (NS) use are based on evidence from studies with methodological flaws. Milk removal during breastfeeding can be impacted by infant and maternal factors other than NS use. The aim of this study was to control electric breast pump vacuum strength, pattern and duration across multiple study sessions to determine if NS use reduces milk removal from the breast. Methods A within-subject study with two groups of breastfeeding mothers (infants < 6 months) were recruited; Control Group (CG): no breastfeeding difficulties; Pain Group (PG) used NS for persistent nipple pain. Mothers completed three randomised 15 min pumping sessions using the Symphony vacuum curve (Medela AG); no NS, fitted NS, and a small NS. Sessions were considered valid where the applied vacuum was within 20 mmHg of the set vacuum. Milk removal was considered as pumped milk volume, and also percentage of available milk removed (PAMR), which is calculated as the pumped volume divided by the estimated milk volume stored in the breast immediately prior to pumping. Results Of 62 sessions (all: n = 31 paired sessions) a total of 11 paired sessions from both PG (n = 03) and CG (n = 08) were valid (subset) with and without a fitted NS. Only 2 small shield sessions were valid and so all small shield measurements were excluded. Both pumped volumes and PAMR were significantly lower with NS use for all data but not for subset data. (All: Volume and PAMR median: no NS: 76.5 mL, 69%, Fitted NS: 32.1 mL, 41% respectively (volume p = 0.002, PAMR p = 0.002); Subset: Volume and PAMR median: no NS: 83.8 mL, 72%; Fitted NS: 35.2 mL, 40% (volume p = 0.111 and PAMR p = 0.045). The difference in PAMR, but not volume, was statistically significant when analysed by linear mixed modelling. A decrease of 10 mmHg was associated with a 4.4% increase in PAMR (p = 0.017). Conclusions This experimental data suggests that nipple shield use may reduce milk removal. Close clinical monitoring of breastfeeding mothers using nipple shields is warranted.

Neonatal breast-suckling skills in the context of lactation and peripartum hormonal changes and additional factors—a pilot study

“…Moreover, the effect of nipple shields used to protect the nipples on breastfeeding duration is unclear. Although nipple shields appear to have no impact on the plasma prolactin and cortisol levels among lactating mothers, they may reduce milk removal from the mammary gland [20][21][22]. In this study, the newborns' suckling skills were assessed to determine the relationship between suckling skills and the duration of breastfeeding as well as the measured Table 6 Correlation between the parameters assessed on second day postpartum and the way of feeding 3 months after childbirth…”

Wunde Brustwarzen in der Stillzeit

“…Stillhütchen sind aus flexiblem Silikon gefertigte Stillhilfen, die meist zum Einsatz kommen, wenn das Saugen an der Brust z. B. durch anatomische Faktoren, erschwert ist [11]. Keine der eingeschlossenen Studien hat diese Intervention untersucht.…”

“…Es wurden keine Daten zu Auswirkungen der Therapie auf Brustwarzenverletzungen erhoben. Eine der Studien konnte eine signifikante Verringerung der Schmerzen bei wunden Brustwarzen direkt nach der Behandlung mittels Soft-Laser aufzeigen 10 . Da im Nachgang keine Daten mehr erhoben wurden, bleibt der langfristige Effekt auf das Schmerzempfinden unklar.…”

Breast Milk Production in Women Who Use Nipple Shields for Persistent Nipple Pain

“…Breast Milk Production and Nipple Shields aim of investigating the effect of nipple shield use on milk transfer in two groups of participants: women using a nipple shield to manage persistent nipple pain (the pain group) and women without nipple pain or other feeding difficulties (Coentro et al, 2020). A within-participant study was conducted in both groups, with two monitored breastfeeding sessions conducted at study visits 2 to 7 days apart and the order of nipple shield use randomized.…”