Breast Shells/Cups.
Breast shells are hard shells worn over the nipple between feedings
and should not be confused with nipple shields (See: Nipple Shields).
They can assist with inverted nipples, provide air circulation
for healing sore nipples and can assist with engorgement. Some
manufactures make the entire shell of a rigid plastic while some
have a soft silicone face that rests against the breast. Hobbit
type shells have large air holes for ventilation. Shells that
provide ventilation are highly recommended. Breast pads that do
not occlude air flow should be worn outside the shell if needed.
Breast shells do have problems. They can cause pressure areas
on the areola that result in plugged ducts. In clinical practice
the author has seen cases where mastitis does not resolve after
antibiotic treatment or recurs in mother who is wearing breast
shells. Solid shells can keep moisture against the breast that
can result in nipple soreness and/or thrush. The milk collected
between feedings in the shells should not be kept to feed to the
baby due to high bacterial contamination (Riordan and Auerbach
432-433)
.
Breast Pumps.
Breast pumps are used to aid in the expression of milk. A breast
pump works by lowering the atmospheric pressure outside the breast
which causes the milk to flow. If a mother does not get a let-down
with the pump, she may only obtain 1/2 to 1 oz. of breastmilk
when pumping. Success with pumps is highly individual; some brands
or models work better for some mothers than others. All pumps
consist of basic parts: A breast flange, a collection area, and
something that produces a vacuum. Pumps that use a squeeze bulb
for suction, despite the size of the bulb, are not recommended.
The suction produced by the pump should be intermittent, not constant.
It is the rhythm of the suction, and compression of the areola
inside the flange that empties the milk in combination with the
suction. Suction alone, will not empty the milk. (Riordan and
Auerbach 419)
Manual Pumps.
Cylinder Types. Create negative pressure by drawing a piston through
a cylinder. The amount of pressure can be controlled. This is
a "Draw and Hold" pump but pulling too hard on the cylinder can
cause too high a pressure. Recommended.
1 Pull or Push Per Second Type. Automatic vents prevent high pressure.
Milk is collected in regular baby bottles for storage. Highly
recommended.
Bulb Types. Create negative pressure by compressing a rubber bulb. The bulb maintains constant suction. Have been known to bruise areola or rupture breast tissue. Rubber bulb cannot be cleaned. Bicycle horn type has no storage reservoir. Not usually used for saving milk. Not recommended.
Semi-Automatic Electric Pumps and Battery Operated Pumps. Are not known for durability. Battery operated need daily battery replacement or rechargeable batteries. Take longer to use than large electric models. Recommended.
Large Electric Pumps. Available on daily or monthly rental basis
are easiest and most efficient pumps for the mother who must pump
frequently. (See: Resources, for pump companies)
These are Medela Pumps http://www.medela.com
Nipple & Breast Creams.
Numerous studies have shown that breast/nipple creams do not assist
in the prevention or healing of sore nipples. Many ingredients
in breast/nipple cream preparations can be hazardous to the newborn.
Breast creams are not normally recommended for the nursing mother
by lactation consultants (Riordan and Auerbach 322-323). Creams is a brief list of some commonly used agents and comments on
each.
Nipple Shields.
There are very few appropriate uses for nipple shields. A nipple
shield is worn over the nipple and areola during feeding, the
baby nurses through the shield. Nipple shields should not be confused
with breast shells ( see above) The nipple shield reduces both
available milk volume and appropriate breast stimulation needed
for continued milk production by 20-58% and can easily result
in infant malnutrition and have been associated with cases of
failure to thrive (Woolridge, Baum and Drewett 357-364; Auerbach
419-427 ; Riordan and Auerbach 287, 427-430). Nipple Shields must
be viewed as a "prescription" device requiring written documentation
of need by clinical impression, a written treatment plan and close
follow-up. Lactation consultants maintain that the nipple shield
is a device with a strong potential for misuse. An informed consent
should be signed by the mother, father and the provider recommending
the nipple shield. (315). [Table 19] Nipple shields can have serious
legal consequences. At least one law suit was filed against a
nurse and the hospital who employed her because she failed to
inform the parents of the consequences of nipple shield use (Bornmann
5).
Feeding Tube Devices.
Both the Supplemental Nutrition System; (SNS) and the Lactaid;
are feeding tube devices whereby the infant can nurse directly
at the breast and receive supplemental breastmilk and/or formula.
The presence of an increased flow organizes the infant suckle,
making nursing more efficient. Feeding tube devices can be used
in cases of failure to thrive, twins, low milk supply, induced
lactation, relactation, breast surgery, retardation, cleft lip-palate
etc.
Feeding tube devices should be viewed as a "prescription" device
requiring written documentation of need by clinical impression,
a written treatment plan and close follow-up. A feeding tube device
has a potential for misuse that may adversely effect the infant's
normal suckling patterns and reduce maternal milk supply if inappropriately
used. Use of the tube system in a normal, healthy breastfeeding
infant solely for formula and/or water supplementation is considered
inappropriate. The goal of feeding tube devices is to stabilize
the infant and maternal milk supply as quickly as possible and
wean the baby from the tubes (Riordan and Auerbach 433-438). The
mother should be referred to a lactation consultant for follow-up
care. Weaning from a feeding tube device may not be possible in
cases of induced lactation, relactation and/or cases of severe
oral motor dysfunction. Depending on availability, the feeding
tube device is filled with either mother's breastmilk or commercial
infant formula.
Copyright Marie Davis, RN, IBCLC 1999
Last reviewed: