One of the situations in which a nipple shield can be useful is in helping an infant latch on to a severely inverted or flat nipple, especially when other measures described above have failed. Mothers who use the shield should be instructed on how to wean the baby off the shield as soon as possible, and should weigh their baby frequently to assure adequate milk intake. For many mothers, use of a shield is the first step in getting her baby to nurse at the breast, and may mean the difference between continuing to nurse or weaning. The mother's ability to feel her baby sucking at her breast may encourage her to continue nursing after other attempts have failed. The mother needs to be encouraged to periodically put her baby on the breast without the shield until she is able to discontinue its use entirely. If the baby will take one breast without the shield, she should nurse him on that breast at each feeding, and use the shield only if the baby won't take the other breast without it. While some babies move quickly from nursing with the shield to nursing without it (sometimes after only one or two feedings) other babies have to be weaned from it gradually. My niece, who had one normal nipple, and one that was severely inverted, used the shield on and off for several months. She monitored her baby's weight gain carefully, and he is now happily nursing (without the shield) at the age of 18 months. Considering the severity of her inversion, I am not sure that her baby would have ever been able to nurse on that breast without the use of the shield.
While use of a nipple shield should only be considered when other measures have failed, it can be a useful tool under the guidance of an experienced lactation professional. Medela offers a several sizes and types of thin, flexible, silicone nipple shields. Because the shields are made of silicone, there is no risk of latex allergy. The thin silicone layer means that more stimulation reaches the areola, and the reduction of milk volume is minimized. Medela also makes a Contact Nipple Shield, which includes an open cut-out section which helps the baby maintain more skin contact with your breast.
During your initial feedings, your baby may be able to open his mouth wide enough and suck vigorously enough to draw the nipple far into his mouth and close his gums on the areola, so the flat or inverted nipple may not present a major problem. Having someone to help you with latch on and positioning can be very helpful.
You will want to nurse as soon as possible after birth, and every 2-3 hours after that. You want to avoid engorgement, because breast swelling can cause the nipples to flatten out, making them more difficult to grasp. (See article on "Engorgement" on Anne's site for tips on how to avoid this problem).
During the initial learning period of breastfeeding, avoid the use of any artificial nipples. Supplement with alternative feeding methods, because the baby who is learning how to nurse, especially on a nipple that isn't the ideal shape for nursing, is more likely to become nipple confused. (See article on "Introducing Bottles and Pacifiers to the Breastfed Baby") to get more detailed information on alternate feeding methods.
If feedings become stressful, stop and comfort your baby. Try rocking, swaddling, walking, giving him your finger to suck, or offer him some expressed milk (or water or formula) until he settles down. You want him to associate feedings with positive feedback, not negative. Supplementing your baby or using a nipple shield temporarily is preferable to having a baby who screams every time you open your nursing bra.
Many mothers with flat or inverted nipples experience some degree of nipple soreness. You may experience soreness as the nipple is drawn into the baby's mouth, and the adhesions are stretched or broken. If the nipple draws back into the baby's mouth during or immediately after feedings, moisture may become trapped and contribute to soreness. Try patting the nipples dry after feedings and apply a thin coating of Purelan 100. See the article on "Sore Nipples" on Anne's site for more treatment options.