A small group of Healthy Children Project faculty were honored to attend and present at the University of Central Lancashire, Maternal and Infant Nutrition and Nurture Unit (MAINN) conference in lovely Grange-over-Sands, England last week. (For highlights of last year’s MAINN conference, visit this page). The MAINN conference has been held not only in the UK, Australia, and Sweden, but next year will be held in conjunction with Healthy Children’s International Conference in Deerfield Beach, Fla. from January 9 to 12, 2018.
This conference brings together researchers and experts in fields that support the establishment of the maternal-infant bond and related issues in nutrition and nurture. The remoteness of this seaside town in the Southern English Lake District created a container for further discussion and networking during and between sessions, as well as before and after the conference day. The schedule of the 3-day conference was prodigious, encompassing six plenaries, 72 breakout sessions, four workshops, and a poster session featuring the work of 17 research teams.
The HCP team offered to share insights with me from the conference, but struggled to do justice to all the learning insights and meaningful intellectual interactions that occurred. Therefore, they decided to blog about what they learned from one particular presentation.
One of the amazing presentations we attended was Renee Flacking’s report on the research that she had done with Fiona Dykes of the UK regarding the use of nipple shields in the neonatal intensive care unit (NICU.) We can’t think of any superlatives beyond “Wow!” to describe the level of excellence, passion, and insight contained in this presentation. In order to collect the data for the ethnographic study, Flacking spent more than 600 hours “living” in four NICUs in Sweden and England. Observations, field notes, and interviews were searched for themes related to parents’ and staff’s perceptions and experiences of using a nipple shield in transitioning a preterm infant to feeding at the breast.
As background, Flacking acknowledged the debate over nipple shield use and presented two influential nipple shield studies: one small study that indicated that transfer of breast milk was enhanced when mothers of premies used a nipple shield to breastfeed (Meier et al., 2000), and a large study that found that premies who were exposed to nipple shields were significantly less likely to continue breastfeeding and to breastfeed exclusively (Kronborg, Foverskov, Nilsson, & Maastrup, 2016.)
Flacking & Dykes found that parents and staff thought of nipple shields as a transitional tool to progress to feeding at the breast, but mothers had some mixed and negative feelings as well. Mothers felt that the need to use a shield indicated that their breasts weren’t good enough and expressed that the nipple shield became a barrier between them and their baby. The researchers found two organizing themes: 1) the need for the baby to learn quicker, in order to get to full breastfeeding faster, and thus the nipple shield could be a short-term bridge to this goal, and 2) the interference of the nipple shield in the relational aspect of breastfeeding; that the shield impacts the development of the relationship between the mother and the baby. Holding these two organizing themes “in balance may be the key to appropriate use of the nipple shield,” Flacking stated.
The mother and baby’s needs must be taken into account in determining strategies to facilitate breastfeeding in a person-centered and ongoing way.
As we thought about and discussed Flacking and Dykes work among ourselves and with others, we couldn’t help but agree that nipple shields are often presented as a quick means to an end (as we have heard mothers complain about “helpers” latching the baby mechanistically like screwing in a light bulb), without taking into consideration the potential negative ramifications of the meaning of the shield to the family. We would never want any mother to think that she was not enough for her baby, that her breast was somehow suspect or inadequate, or that a piece of silicon could come between her and her baby. Particularly when we are working with the potential of feelings of inadequacy or guilt coming from the incomplete pregnancy, we must assume that mothers need help decoding the meaning.
We also pondered the resonance between Flacking and Dykes’ findings and those of Kronborg and colleagues, who cited that while nipple shields may be help mothers in the early period, but are “not necessarily a supportive solution to the inexperienced mother who needs extra support in the early process of learning to breastfeed.”