Perceptions and experiences of using a nipple shield among parents and staff - an ethnographic study in neonatal units

Abstract

Background: Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may
be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only
as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However,
the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and
experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England.

Methods: An ethnographic study was undertaken where observations and interviews were conducted in four
neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis.

Result: The global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing
themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes,
‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic
themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a
nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes
show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting
the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time
as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized.

Conclusion: This study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to
help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother
and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore,
we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these
in balance may be the key to appropriate use of the nipple shield.