Women’s lived experiences of nipple shields to support breastfeeding

Blog post written by Rebekah Burrow, NIHR Pre-doctoral Fellow, and Dr Emily McFadden, Departmental Lecturer and Senior Statistical  Epidemiologist at the Nuffield Department of Primary Care Health Sciences at the University of Oxford

Background

Breastfeeding* is associated with better health outcomes, particularly for babies born prematurely. However, lots of babies struggle to latch on to the breast to breastfeed, especially babies who are born prematurely. Also, lots of women and people stop breastfeeding earlier than they want to because of the pain they experience when breastfeeding.

A nipple shield is a very thin, flexible piece of silicone that is placed over a nipple to help a baby latch on, or to reduce breastfeeding pain. They have a cone shape to go over the nipple, a flat base that covers the areola to hold them in place, and tiny holes in the cone to allow milk to flow into the baby’s mouth. Women have been using different types of nipple shields for hundreds of years but we still do not know if they are safe or helpful.

Women’s experiences of using modern nipple shields are hugely varied. Notably, these experiences often differ from the recommendations in clinical guidelines and the training and perspectives of health care professionals and others who support breastfeeding.

Whose lived experience?

Our personal feeding experiences with nipple shields inspired this project. Talking with friends we learned that many of them had used nipple shields too. More had considered using them, but been afraid to, fearing reduced milk supply, mastitis, and their baby becoming addicted to the shields. Women often didn’t feel they had a choice – some were told they must use them, others that they must not. Many felt they had to use them in secret. Nipple shields worked for some women and babies, for others they did not. All women described not having enough information to feel confident and be supported in their choices.

We listened to more, different, women, beyond our own connections. They described struggles with latching, pain, exhaustion, healing, infections, mental health, their baby’s health, and a lack of useful information and support. With their support we planned a systematic review (to gather all the existing relevant evidence) and a co-production workshop (to work out how to explain the evidence) to start to provide the information we are lacking.

Shaping the project

Listening to women’s experiences, both those breastfeeding, and those supporting breastfeeding, showed us how critical it was to seek out and listen to more different women. Every person we spoke to has shaped the project. They suggested that we:

• increase the types of evidence we look at
• consider certain population groups, especially those often under-served
• consider different clinical settings
• examine the shields alongside the support available to use them
• ensure we have different and appropriate ways to communicate with those who are breastfeeding, or who support breastfeeding.

The review is still underway and the project is already changing women’s experiences. Pregnant and breastfeeding women and people, and those supporting them, searching online for evidence about nipple shields, are finding our project and learning that the answers they are looking for are not yet available. Some of them are contacting us, to share their personal experiences, their questions, and to offer to support the project.

What next?

In May this year, in a co-production workshop, women with lived experience, together with healthcare professionals and others who support feeding, will choose the results of the review that are the most useful for them. Together we will work out how to explain the results and how to share them with others. We are hugely excited to find out what the results are, and how to make them useful for women.

For whom?

Breastfeeding is a critical component of public health globally.

However, our research team are based only in the UK. Most of the women we have spoken to live in the UK. Our review search terms are in English. Most of the studies that we have found were undertaken in North America, Europe, or Australasia.

We have consulted with a lactation consultant in Peru. We have found and included studies from Brazil, India, Iran and Thailand. We welcome advice from women in Asia, Africa and South America on how to make the review more relevant and useful; please email us. We will provide the results in at least four languages in addition to English.

• We recognise that this will not be sufficient to provide globally equitable information about nipple shields. We welcome collaboration with partners to make this work useful for more women; please get in touch if you might be able to help.
• We are searching for a feminist medical historian with whom to collaborate – please get in touch if you might be interested.

Read more about the project here. 

Further information:

• Nipple Shields to Support Breastfeeding: systematic review and co-production of dissemination materials (SPCR Award 752)
• In partnership with the University of Bristol, Rebekah Burrow, Emily McFadden, Julian Treadwell, Lucy Goddard 

*Breastfeeding includes chest-feeding. Chest-feeding is a term preferred by some people whose gender is not female, who have had gender-affirming surgery, or who have had a partial mastectomy.

** We have chosen to use accurate and inclusive language selected by women and people with recent experience of pregnancy, breastfeeding or chest-feeding. When we describe exclusively female people we use the terms “women”, “pregnant women” and “breastfeeding women”.