Reviewing the evidence to help you make informed decisions about breastfeeding support
Background
Breastfeeding is associated with better health outcomes, especially for babies born prematurely. However, many women and people are unable to start breastfeeding, or stop earlier than they would like. Often this is due to difficulties getting the baby to “latch on” to the breast, and/or breast and nipple pain. A nipple shield may be able to help babies to latch and reduce pain for people. It might also help to establish breastfeeding in a hospital setting. However, there is no consensus as to whether nipple shields are safe or helpful for breastfeeding people and their babies, or the best context or timing in which to introduce them.
What will we do?
We will systematically review the existing evidence. We will work with people with experience of breastfeeding, or of not being able to breastfeed, and health care professionals and others who provide feeding support, to discuss what really matters to them and how we should prioritise and present our results so that the results reach people who may benefit from using nipple shields, and people who support breastfeeding.
What are nipple shields and why do they matter?
Lots of babies struggle to latch on to the breast to breastfeed, especially babies who are born prematurely. Also, lots of people stop breastfeeding earlier than they want to because of the pain they experience when breastfeeding.
A nipple shield is a very thin, flexible piece of silicone that is placed over a nipple to help a baby latch on, or to reduce breastfeeding pain. They have a cone shape to go over the nipple, a flat base that covers the areola (skin around the nipple) to hold them in place, and tiny holes in the cone to allow milk to flow into the baby’s mouth.
Why do we need research?
The most recent review of evidence about nipple shields was published over 10 years ago, and does not follow rigorous, systematic methods, or consider key outcomes that are important to those breastfeeding. There is a lot of conflicting information about whether nipple shields are helpful or safe. People have very different experiences - one woman told us “nipple shields were what saved us”. Another told us “it was a tool that wouldn't fit”. Women have described to us:
- being recommended nipple shields by friends
- being told they must or must not use nipple shields by health care professionals
- not being able to find information about whether nipple shields “work” or how safe they are
- not being able to access support to use them
An up-to-date high-quality systematic review is needed to summarise the evidence. Patient and Public Involvement (PPI) and User Involvement (health care professionals, and others who provide feeding support) is needed to prioritise reporting of outcomes that matter to those breastfeeding and their supporters, in a way that is accessible, useable and used.
Aim
To enable people who might want to use nipple shields, and people who provide feeding support, to:
- be able to easily find and understand the information that really matters to them
- enter into shared decision-making
- make their own informed decisions about whether or not to use nipple shields to support breastfeeding
How patients and the public Are involved
We have already discussed this project with Patient and Public contributors with different experiences of nipple shields, a health care professional and a community-based breastfeeding supporter. We asked about their experiences and priorities, and how they thought PPI and User Involvement should be included in this research.
We have embedded PPI and User Involvement throughout our project. We will work together with contributors, representing diverse demographic, social and economic, and health factors to define which questions, outcomes of breastfeeding, and of nipple shield use (or not), are most important to them. We will host a workshop where we will work together with PPI contributors and User contributors to co-produce our dissemination materials and the co-design of our dissemination strategy.
This project is funded by the NIHR School for Primary Care Research, and led by Rebekah Burrow and Emily McFadden.
Partner organisations
- University of Bristol
Here's an easy to read blog about this project!
Breastfeeding includes chest-feeding. The vast majority of breastfeeding people are female in sex and gender. Chest-feeding is a term preferred by some people whose gender is not female, who have had gender-affirming surgery, or who have had a partial mastectomy.
YOU CAN HELP
Are you interested in learning more about this project?
Maybe you could even help us to get this research right?
You will receive £25 per hour, plus expenses, for your time.