title: Women's use of nipple shields-Their influence on breastfeeding duration after a process-oriented education for health professionals.
abstract: OBJECTIVE
  This study investigated if a process-oriented training for health professionals will influence women's use and reasons for using a nipple shield, the baby's weight, and the duration of breastfeeding.
  
  
  METHODS
  An intervention was performed for health professionals that included a process-oriented training program on breastfeeding support. Primiparas living in either the intervention municipality or in a control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with those for the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, at 3 months, and at 9 months postpartum.
  
  
  RESULTS
  The mothers' use of nipple shields related to the finding that if the women had a higher body mass index in the beginning of the pregnancy, the babies had difficulty in grasping over the nipple, and the mothers had pain or wound on the nipple. For the mothers in the IG group, there was no significant difference if they had used nipple shields or not in relation to breastfeeding duration. In contrast, the mothers in the control groups had a significant shorter breastfeeding duration if they had used nipple shields. In the IG, there were no significant difference between the use of nipple shields and the babies' weights at 3 or 9 months. The babies of women in the CGB who used nipple shields had a significantly lower weight at 3 months than the babies of those who did not use nipple shields (p=0.02).
  
  
  CONCLUSIONS
  A process-oriented training in breastfeeding counseling prolongs the duration of breastfeeding for women with breastfeeding problems, where the problems are remedied by the use of nipple shields.
authors.affiliation: 1 School of Health and Education, University of Skövde , Skövde, Sweden .
authors.forename: Anette
authors.initials: A
authors.lastname: Ekström
authors.forename: Hanna
authors.initials: H
authors.lastname: Abrahamsson
authors.forename: Rose-Marie
authors.initials: RM
authors.lastname: Eriksson
authors.forename: B Lena
authors.initials: BL
authors.lastname: Mårtensson
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000009:adverse effects*; D005260:Female; D006282:Health Personnel; D006293:Health Promotion; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008137:Longitudinal Studies; D009035:Mothers; D009558:Nipples; D010146:Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011181:Postnatal Care; D011482:Protective Devices / Q000706:statistics & numerical data; D013391:Sucking Behavior; D011795:Surveys and Questionnaires; D013997:Time Factors; D015430:Weight Gain