Tuesday, 21 May 2013

Triumphant Tuesday: When Pacifiers and Nipple Shields Are Friends in Disguise

Pacifiers and nipple shields have a bad rap, and rightly so. However if used sparingly, and no earlier than 4 weeks, they can act as transitory crutches, enabling mothers to breastfeed for longer. In fact, if a mother is set on using interventions, then pacifiers and nipple shields are more compatible with breastfeeding than formula top ups.

This week’s triumphant mom found breastfeeding to be a turbulent journey. When a bad latch led to severe nipple damage, she hesitantly introduced a pacifier and nipple shield to provide temporary respite from the pain.



My pregnancy was problem-free.  I travelled, I studied, I worked, I rested as I needed and took a pregnancy multi-vitamin.  My due date according to last menstruation (and a clockwork 28 day cycle) was February 9th.  The 12 week ultrasound said 14th February.  I did not put on any weight during my pregnancy (which given my high BMI, was never an issue) and I ‘passed’ all the tests with flying colours.  My blood pressure was never an issue, the blood glucose test came back normal, and my baby was growing normally.  I felt great and was looking forward to meeting my baby.

My due date arrived, February 9th.  I woke at my usual time in the morning, feeling ‘off’.  I suggested to my husband that he may need to be available.  He decided to go to work and tie up loose ends, then come home.  By morning tea time, I was thinking it was labour (my plug was lost, and my off feeling was now a pulling down feeling coming in waves).  I swivelled on the big ball, walked up and down the hall, and by 11am decided it was labour.


The Birth

My husband was instructed to waste no time and head home.  He was home by 12, and made lunch.  As he ate, he timed my contractions.  They were steady, 5 minutes apart and lasting 1 minute.  So by 2pm, we were at the hospital.  About 4pm, I was feeling restless and ‘over it’ (transition), and got into the bath.  By 5pm, I had birthed my baby into the water.

Emergency: Whisked to Another Hospital

A few minutes after my baby was born, the gorgeous and peaceful birth became a panic.  The midwife discovered that the unclamped cord had come away from the placenta (we later learned it had been a velamentous cord insertion).  My baby was small (2.6kg) and pale.  It was assumed there had been blood loss and with baby being small, it wouldn’t take much to cause a drama.  So we were transferred to the NICU at a different hospital (my placenta was hurriedly removed so that I could follow the ambulance).

At 7pm we were at the NICU.  Here it was determined that my baby was fine, just small, and a glucose drip was given as a precaution.  The nurse said that if my baby breastfed overnight, we would be fine to go home the next day.  I was placed on the ward, and was to be called up to the NICU when needed.

Two hours after birth, my baby was given to me for the first breastfeed.  I had been waiting for this moment for what felt like a lifetime.  Baby latched without effort, and fed for as long as needed.  I was called up over night, and repeated the process. But this successful pattern of feeding was not to last.

Hospital Negligence

Unfortunately, a misguided NICU nurse turned up the glucose drip.  This meant my baby did not ask for a feed.  Consequently 6 hrs passed between baby’s last feed (and subsequent increase in the drip) and my waking up realising.  At 8am, we tried to feed, without luck; the nurse poked and squeezed me, sighed and made me feel terrible.  This was not what was meant to happen.

When the registrar arrived at 10am he was furious that the drip was up, and said that we would have to stay as the drip needed to be dropped down slowly, breastfeeding would increase and we could then go.  By 5pm that night, this process was complete, and we were both put on the ward for another night of observation.


My husband over-nighted with us on the ward.  Finally we were together as a family.  I fed my baby on demand, for as long as it took, and dutifully recorded wet and dirty diapers.   We were released about 10 am the next day (36 hrs post birth).

The next 6 weeks were the most difficult in my life.  Breastfeeding was the greatest challenge.
My baby seemed to be a slow feeder.  Each feed took an hour (sometimes more).  And baby fed every 2 hours.  My mother had breastfed twins, so if she could do it, I could manage one!  She told me that she had focused on breastfeeding, that she made herself comfortable and just fed.  She read while she fed, so that is what I did.

Nipple Damage

One night, in my tired state, I attempted to lay down and feed.  I had seen a friend do it.  It seemed straightforward.  But I got a bad latch which I ignored.  The damage led not just to grazes, but to chunks out of my nipples.  The pain would shoot down my back as my baby fed (toe curling, tear inducing pain).  It got to the point where I would dread each feed.  The anticipation of the feed was enough to make me cry.


As the weeks went by, my baby thrived, was putting on weight, growing nicely, was alert and reasonably happy.  But breastfeeding was not a joy.  Something was not right - maybe it was the latch, maybe it was just that the damage wasn’t healing...I didn’t know.

Introducing a Pacifier

At 4 weeks old, I introduced a pacifier.  I had never wanted to use a pacifier, was aware of nipple confusion and did not wish my baby to become dependent on it.  But all baby did was suck, suck, suck!  The pacifier seemed to help.  Yet still the damage to my nipples was not healing and I was at a loss.  I had gone through two tubes of Lansinoh.

Introducing a Nipple Shield

As we approached 6 weeks, I rang the Australian Breastfeeding Association helpline.  I don’t know if it helped or not, maybe it did.  But against advice - I got nipple shields.  The first pair I got were too small (I had mistakenly chosen based on my baby’s mouth, not my nipples).  So I got a second pair.  I used the shields at every feed for 3 days.  I even managed to feed in public (under a muslin wrap so I could attach the shield without exposing myself).  On the 3rd night I woke to feed, and latched baby on.  We fed painlessly.  It was a joy.  This is what breastfeeding was supposed to feel like.  Then I realised, I had forgotten the shield.  I was breastfeeding without the shield!


From that moment on, we never looked back.  I breastfeed my baby for four years. I breastfed through pregnancy, and tandem fed for 2 years.  I am now a doula.

I know my success came down to self -determination.  In my mind, there was no alternative.  Breastfeeding would work.  There was no reason for it not to.”




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3 comments:

Athena said...

I think this is a great story to show how nipple shields and dummies can be used as tools to facilitate breastfeeding when it's in danger. It was definitely the right call to use them in this situation rather than discontinue breastfeeding!

Zoe Jones said...

Wish I'd thought to use nipple shields while building my nursing relationship with my two ULT boys. In my defence I had no idea my third baby had a ULT and by the time I'd educated myself enough to realize my fourth did we had already achieved a workable latch, not perfect, but it was doing what it needed to do.

Nichole said...

I told my nurse that I didn't think my son was latching on right. He wasn't and needless to say, I had severe nipple damage as well. The shield was my saving grace as well. There would have been no way I could have continued with breast feeding any other way. I probably used it during healing for two weeks. I nursed my son until 9 months.

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