Dr. Sharon Perrella

Many women plan to breastfeed their babies; when faced with challenges it can be a very stressful experience. Sharon's passion is to contribute to the growing body of evidence around human lactation, particularly in the areas of preterm infant feeding, low milk supply and sucking anomalies, to facilitate evidence based care of the breastfeeding dyad.

Sharon's clinical background includes paediatric nursing, midwifery and neonatal intensive care nursing. An extended 'breastfeeding practicum' came with mothering three children. Sharon subsequently qualified as an Australian Breastfeeding Association breastfeeding counsellor, and then an International Board Certified Lactation Consultant. A PhD thesis titled ‘The effect of different types of nutrition on the gastrointestinal response of the preterm infant’ was completed in 2014 with the Hartmann Human Lactation Research group at The University of Western Australia, where Sharon now works as a research fellow. 

Absract: Do nipple shields help or hamper breastfeeding in mothers with nipple pain?

Nipple shields may be used to assist with infant attachment at the breast, or to manage maternal nipple pain associated with breastfeeding. While many mothers report they are helpful (1), there are concerns that nipple shield use may limit the amount of milk transferred from the breast and therefore contribute to reduced milk production (2). There is also some evidence to suggest that nipple shield use may impact the strength and rate of the infant’s sucking during breastfeeding (3,4). The published studies of investigations of nipple shields have limitations such as the use of shields of different types, thicknesses and materials.  Further the study designs have not evaluated milk transfer adequately.  As such we have a limited understanding of the mechanics of milk removal from the breast in term infants feeding with a nipple shield. This knowledge is necessary to ensure appropriate use and monitoring of nipple shields in the clinical setting. This gap in knowledge has prompted us to investigate effect of nipple shield use on milk transfer, infant sucking dynamics and maternal nipple pain.

We are currently investigating a group of breastfeeding dyads where the mother routinely uses nipple shields for unexplained nipple pain to determine milk transfer and maternal nipple pain for breastfeeding with and without a nipple shield. Outcomes will be compared to a group of breastfeeding dyads with no breastfeeding complications.  For each dyad we have monitored two breastfeeds on separate days; one with and one without a nipple shield. Maternal pain questionnaires and salivary cortisol levels as well as infant milk transfer and sucking strength are recorded at each study visit. Mothers also measure their 24hr milk production, and we use this data to also calculate the proportion of available milk removed from the breast at each study visit, giving a more accurate estimate of the effectiveness of milk removal.

In this presentation, we will explore preliminary findings, comparing infant milk transfer volumes and proportions of available milk removed from the breast as well as maternal ratings of pain for breastfeeds with and without a nipple shield. Potential implications for clinical practice will be discussed.

References

(1). Kronborg H, Foverskov E, Nilsson I & Maastrup R. (2017). Why do mothers use nipple shields and how does this influence duration of exclusive breastfeeding? Matern Child Nutr 13(1). doi: 10.1111/mcn.12251.

(2). Chow S, Chow R, Popovic M, Lam H, Merrick J, Ventegodt, Milakovic M, Lam M, Popovic, M, Chow E & Popovic J. (2015). The use of nipple shields: a review. Front Public Health. 3, p.326. doi: 10.3389/fpubh.2015.00236

(3). Woolridge M, Baum J & Drewett R. (1980). Effect of a traditional and of a new nipple shield on sucking patterns and milk flow. Early Hum Dev 4(4). doi.org/10.1016/0378-3782(80)90040-7

(4). Perrella S, Lai T & Geddes D. (2015). Case report of nipple shield trauma associated with breastfeeding an infant with high intra-oral vacuum. BMC Pregnancy Childbirth 15:55. doi.org/10.1186/s12884-015-0593-1