July 11, 2025 • 14 mins
Nipple shields can be valuable, often temporary tools that help overcome breastfeeding challenges like flat or inverted nipples, painful feeding, or difficulties with preterm babies. When used appropriately with professional guidance, they can help maintain the breastfeeding relationship while addressing specific issues.
• Nipple shields are thin silicone devices that fit over the nipple with holes for milk flow
• Best used under guidance of a lactation consultant as a temporary solution
• Particularly helpful for flat/inverted nipples, preterm babies, and painful nipples
• Can serve as transition tools from bottle to breast
• Available in sizes from 16-24mm, with 20mm being the standard starting size
• May reduce milk transfer in some cases but can enable breastfeeding that might otherwise be impossible
• Clean after each use and wash thoroughly multiple times daily
• Mark clear shields with permanent marker to prevent losing them
• When weaning off shields, try direct breastfeeding when baby is hungry but not frustrated
• May need to pump after shield feedings to maintain supply
Reach out at birthlearning.com if you need help with your pregnancy or breastfeeding journey.
Visit our website, here: https://birthlearning.com/
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice, helping thousands of
people prepare for labor,providing essential knowledge
and tools for positive andempowering birth experiences.
Speaker 2 (00:47):
Hello, welcome to the Ordinary Doula podcast.
This is your host, angie Rozier, and today we're going to
address a little bit more on thelactation side of things.
We're going to address nippleshields.
Sometimes nipple shields get abad rap in the breastfeeding
world, sometimes they getoverused, sometimes they get
(01:07):
underused.
But we're going to kind ofaddress that today and talk
about good times to use them andwhen to not use them and how to
stop using them.
So, nipple shields let's talkabout first what a nipple shield
is, and it is best to use anipple shield under the guidance
of a lactation consultant,because it's a great tool but
(01:32):
it's, yeah, like I said,underused and overused sometimes
, or misunderstood.
So use it with a little bit ofguidance.
So, first of all, a nippleshield.
I want to just define what itis.
It's a very thin, flexiblesilicone device that goes right
over right on the breast, goesover the nipple and the areola.
There's little holes in the endof it so milk flows right
(01:53):
through it.
So the baby's still on thebreast, but it does have this
little silicone barrier.
Um, it used to be back in thelong ago.
There were metal and woodenversions of this in different
centuries and now we have areally nice soft, flexible
silicone material that is muchbetter than anything they've had
in the past.
So size and fit does matter.
(02:14):
So if you're using one, makesure that the size and fit is
good for the baby, the baby'smouth, the mom's n and what it
is we are working with there.
So some I know that hospitallactation consultants kind of
have a reputation for usingthese quickly, whereas some
(02:35):
private consultants may not usethem as much.
I trained in both private andhospital practice and work in
both private and hospitalpractice and I like the Nipple
shield.
It's not my first go-to by anymeans, but in a lot of cases it
has a lot of different purposesfor use that can be very helpful
that nothing else really cantouch on.
(02:56):
I do generally recommend it tobe used very temporarily.
Very rarely do nipple shieldsneed to be used throughout the
entire breastfeeding journey,but it can be a tool in the
beginning, kind of like a littlecrutch, if you will, just kind
of a helping hand until thingschange, like baby's mouths grow
and milk supply comes up andnipples create a little more
(03:17):
elasticity.
Sometimes that nipple shield isexactly what we need.
So some very obvious casesyou'd want to use a nipple
shield is if we have a flat orinverted nipple.
The nipple shield is simply anextension of the nipple right
and it's a soft little extensionthat the baby can feel in the
back of its mouth a whole lotmore easily than it can a flat
(03:38):
or inverted nipple and nipplescome in all shapes and sizes
right.
Some people don't ever need touse a shield and other people
will need to rely pretty heavilyon one.
So for babies to get the reflexto suck and keep sucking, the
very back of their palate has tobe touched.
Now breasts and nipples can besucked back to that spot, but it
(04:02):
takes a few sucks and it's notlike we can explain to a baby
like, hey, just suck for 30seconds and you've got it.
And some tiny little mouthsdon't have the capacity or the
strength yet as they're learningto pull.
A challenging nipple might beflat or inverted all the way
back.
So in those cases we do lean onpretty heavily and are grateful
(04:23):
for the tool of a nipple shield.
I would say truly invertednipples, which are pretty rare.
Actually, that's the mostimportant and the longest term
use of a nipple shield is withtruly inverted nipples, flat
nipples can be pulled out.
Inverted nipples can be workedwith, sometimes too, again
depending on the size, shape,strength of the baby's mouth too
(04:45):
.
Sometimes we have a pretermbaby or a low tone baby whose
suck is kind of weak and theyneed a little bit extra firmness
, if you will like something tograb onto while they're learning
, growing and developing.
We may have a lip or tongue tiethat inhibits the baby's tongue
from being long and doing agood long pull.
(05:06):
So, having a longer nipple, wecan accommodate a shorter tongue
or a tighter tongue.
If people choose not to get atongue revision or whatever,
then sometimes that nippleshield makes breastfeeding with
a tongue tie possible in thosecases.
Sometimes nipple shields areused because the nipples are
trashed.
They might be cracked, bleeding, very painful, and it can be a
(05:28):
friction barrier that littlesilicone can go over.
The baby can still latch, be atthe breast and feed while those
nipples are healing, ratherthan have the continued friction
from the baby's mouth.
And then sometimes nippleshields another great tool for
them is a transition tool.
So maybe we have a baby who hashad a whole lot of bottles for
whatever reason.
(05:49):
They've been in the NICU.
We started out with bottles,whatever that might be that
babies kind of get used to again.
They need that back of theirmouth, stimulated, their soft
palate, to keep them sucking andbottles travel straight back
there.
Right Pacifiers go straightback to that spot and keep it
stimulated.
Fingers if the baby's suckingon mom's or dad's finger, that
(06:12):
goes straight back to the spot.
But the breast again needs tobe sucked a little bit back
there and babies are kind ofunreasonable people.
We can't tell them, just suck afew times, that'll get better.
So if we're wanting them tocome off a bottle and go back to
the breast a little more, thatmight be an in-between tool.
So it's kind of a compromisebetween a bottle and purely on
(06:33):
the breast so that nipple shieldcan go back, stimulate that
suck reflex on the back of theirsoft palate and then as baby
grows and gets stronger we cankind of come off of that so that
the baby can take the breastitself and the nipple back there
.
So nipple shields do have somebenefits.
They assist with latch andsuction when babies are
(06:55):
struggling.
They can protect sore nipplesso the mom can continue to
breastfeed rather than to stopor or um pause her breastfeeding
.
They can allow breastfeeding tocontinue instead of switching
to bottle or formula if we're indanger of that happening, say
with a tongue tie or something,um, and they can be really great
for NICU or preemie in thatcontext to promote milk transfer
(07:18):
and have the baby eating at thebreast even if it's not totally
eating at the breast.
A nipple shield a lot of timeswe'll use them to if we're using
an SNS or a supplementalnursing system.
Maybe we have pumped colostrumor milk that we're putting
through this tiny tube where wehave formula and that nipple
shield can be kind of astabilizer for that little tube,
whether we put it in the frontor the back of that.
(07:40):
That can help.
So baby's still at the breastbut they're having a little bit
of extra help from a couple ofcontractions and sorry
contraptions and we're gettingbreast stimulation.
At the same time the baby'sbeing fed.
So a lot of times this iswaiting for the milk to come in,
of course.
So some drawbacks to using umnipple shields it can reduce
(08:02):
milk transfer some kindsometimes and reduce supply.
So baby might not get as muchmilk um, sometimes they get more
if they're not getting any atall, but they might not get as
much with a nipple shield asthey are, as they might with
just on the breast.
Um, sometimes it is morepainful for the mom to use a
nipple shield Not always forsure.
(08:24):
I'd say.
The vast majority of the timethe nipple shield's more
comfortable, especially with asore nipple.
But sometimes it's more painfulto use that shield.
Sometimes it gives babies alittle crutch some like latch
dependency.
They become reliant on thatshield and they may not want to
breastfeed, and we'll talk in amoment how to wean off of a
breast or a nipple shield.
It does reduce skin to skincontact, right.
(08:46):
So some nipple shields,depending on the brand, have a
little notch cut out for thenose so the baby can still smell
.
You know the Montgomery glandsand what they're doing but it
does reduce some skin to skincontact right in the baby's
mouth and can inhibit somehormone feedback loops.
However, we can have a lot ofother skin-to-skin going on with
the rest of the mom's breastbody and the baby's body as well
(09:09):
.
This is something to clean,right.
It's something to keep track of, something that needs cleaning.
So we want to make sure it'scleaned properly, rinsed very
frequently, cleaned with soapand water a couple times a day,
depending on how often you'reusing it.
A lot of these nipple shieldsare clear silicone.
They get lost in bed sheetsreally easily.
If you're washing them in soapywater they disappear.
(09:31):
So I often suggest to myclients to put a line of Sharpie
like a permanent marker on theedge of that so that you can
kind of see it.
It's easier to keep track ofthat way.
Some people are worried aboutweaning off of the nipple shield
.
That might be a hesitancy touse that shield, but I have seen
(09:52):
in many cases where it makesall the difference and we can
continue breastfeeding.
So with nipple shields, again Ilove them.
Well, I love them temporarily.
So I like them to always be atemporary tool.
And when you go to use a nippleshield and hopefully you're
working with someone to help youhave a weaning plan from the
(10:13):
get-go.
Like be ready to not use thistool sometime.
Um, sometimes, right afterbreastfeeding with a shield, we
might want to pump a little bitjust to maintain that supply,
because the baby might again,you know, it's just kind of a
barrier between mom and baby andmight not stimulate the breast
as well and then try it without.
Just as you try to look atweaning, sometimes you can use
(10:36):
the motivation of being hangryfor that baby to latch just
latch on to the back for a deeplatch, for efficient milk
removal, for minimum, you know,discomfort for anyone, for mom
or baby.
And clean shields like rinsethem after each use, wash them a
few times a day, depending onhow long you're using them.
Some people will have a coupleof them around the house,
(10:56):
wherever it is.
They kind of have their littlebreastfeeding stations.
So, just to wrap it up, shieldscan be a helpful tool,
sometimes a vital tool,especially in early or
challenging situations, right,depending on what we've going on
.
But make sure you kind ofmonitor the use of that, seek
professional guidance, as you'rejust considering, like you know
(11:19):
, work with an IBCLC, as you'reconsidering a shield or kind of
winning off a shield.
So the nipple shields come insizes between 16 millimeters to
24 millimeters.
The hospitals I work at haveand I think it's pretty standard
16, 20, and 24 millimeters.
We always start with 20.
Like, we'll just kind of startwith a 20 millimeter, unless we
(11:41):
have a really tiny baby.
Say we have a five pounder, ababy in the NICU or something
we'll do.
The 16.
Very rarely are we'll do.
The 16, very rarely are wegoing to do the 24 millimeter
one?
Um, if we have a pretty largeyou know lga, pretty large baby
or very large nipples, again,nipples come in sizes between
like 10 and 30 millimeters.
Um, but with the nipple shieldor that that just covers the
(12:05):
nipple, we're not as um, wedon't have to be.
The nipple shield that justcovers the nipple were not, as
we don't have to be as accurateas we would say with a flange
fitting.
But I have worked with, I'veworked with a mom who had very
large nipples they were some ofthe largest that you'll see with
30 millimeters across, which isabout an inch, and she had a
four pound baby.
So that was tricky and we did alot of pumping when we were
(12:28):
able to.
We had to use the nipple shieldfor a little while for that
baby to kind of learn tobreastfeed.
So, again, a temporary tool, butrealize that it is a tool
Rather than ending abreastfeeding journey.
Hopefully you can use tools tocontinue it and to get it to a
spot where you want it to be.
You can use tools to continueit and to get it to a spot where
(12:50):
you want it to be.
So thanks so much for beingwith us here today.
Hopefully this may haveanswered some questions that
you've had or given you somethoughts or ideas on how to
improve or enhance yourbreastfeeding journey.
Nipple shield could be a greattool.
Usually, it's a very temporarytool.
Hope you keep that in mind asyou go about your breastfeeding
journey.
We wish the very best for youand if there's anything we can
(13:15):
do to help, please feel free toreach out.
You can find us atbirthlearningcom and we'd love
to help you on your pregnancy orbreastfeeding journey.
This is Angie Rozier, withOrdinary Doula Podcast signing
off and, as always, go out andmake a great human connection
today.
See you next time.
Speaker 1 (13:46):
Thank you for listening to the Ordinary Doula
podcast with Angie Rosier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Thank you.
Welcome to the Ordinary Doula Podcast with
Angie Rozier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice, helping thousands of
people prepare for labor,providing essential knowledge
and tools for positive andempowering birth experiences.
Speaker 2 (00:47):
Hello, welcome to the Ordinary Doula podcast.
This is your host, angie Rozier, and today we're going to
address a little bit more on thelactation side of things.
We're going to address nippleshields.
Sometimes nipple shields get abad rap in the breastfeeding
world, sometimes they getoverused, sometimes they get
(01:07):
underused.
But we're going to kind ofaddress that today and talk
about good times to use them andwhen to not use them and how to
stop using them.
So, nipple shields let's talkabout first what a nipple shield
is, and it is best to use anipple shield under the guidance
of a lactation consultant,because it's a great tool but
(01:32):
it's, yeah, like I said,underused and overused sometimes
, or misunderstood.
So use it with a little bit ofguidance.
So, first of all, a nippleshield.
I want to just define what itis.
It's a very thin, flexiblesilicone device that goes right
over right on the breast, goesover the nipple and the areola.
There's little holes in the endof it so milk flows right
(01:53):
through it.
So the baby's still on thebreast, but it does have this
little silicone barrier.
Um, it used to be back in thelong ago.
There were metal and woodenversions of this in different
centuries and now we have areally nice soft, flexible
silicone material that is muchbetter than anything they've had
in the past.
So size and fit does matter.
(02:14):
So if you're using one, makesure that the size and fit is
good for the baby, the baby'smouth, the mom's n and what it
is we are working with there.
So some I know that hospitallactation consultants kind of
have a reputation for usingthese quickly, whereas some
(02:35):
private consultants may not usethem as much.
I trained in both private andhospital practice and work in
both private and hospitalpractice and I like the Nipple
shield.
It's not my first go-to by anymeans, but in a lot of cases it
has a lot of different purposesfor use that can be very helpful
that nothing else really cantouch on.
(02:56):
I do generally recommend it tobe used very temporarily.
Very rarely do nipple shieldsneed to be used throughout the
entire breastfeeding journey,but it can be a tool in the
beginning, kind of like a littlecrutch, if you will, just kind
of a helping hand until thingschange, like baby's mouths grow
and milk supply comes up andnipples create a little more
(03:17):
elasticity.
Sometimes that nipple shield isexactly what we need.
So some very obvious casesyou'd want to use a nipple
shield is if we have a flat orinverted nipple.
The nipple shield is simply anextension of the nipple right
and it's a soft little extensionthat the baby can feel in the
back of its mouth a whole lotmore easily than it can a flat
(03:38):
or inverted nipple and nipplescome in all shapes and sizes
right.
Some people don't ever need touse a shield and other people
will need to rely pretty heavilyon one.
So for babies to get the reflexto suck and keep sucking, the
very back of their palate has tobe touched.
Now breasts and nipples can besucked back to that spot, but it
(04:02):
takes a few sucks and it's notlike we can explain to a baby
like, hey, just suck for 30seconds and you've got it.
And some tiny little mouthsdon't have the capacity or the
strength yet as they're learningto pull.
A challenging nipple might beflat or inverted all the way
back.
So in those cases we do lean onpretty heavily and are grateful
(04:23):
for the tool of a nipple shield.
I would say truly invertednipples, which are pretty rare.
Actually, that's the mostimportant and the longest term
use of a nipple shield is withtruly inverted nipples, flat
nipples can be pulled out.
Inverted nipples can be workedwith, sometimes too, again
depending on the size, shape,strength of the baby's mouth too
(04:45):
.
Sometimes we have a pretermbaby or a low tone baby whose
suck is kind of weak and theyneed a little bit extra firmness
, if you will like something tograb onto while they're learning
, growing and developing.
We may have a lip or tongue tiethat inhibits the baby's tongue
from being long and doing agood long pull.
(05:06):
So, having a longer nipple, wecan accommodate a shorter tongue
or a tighter tongue.
If people choose not to get atongue revision or whatever,
then sometimes that nippleshield makes breastfeeding with
a tongue tie possible in thosecases.
Sometimes nipple shields areused because the nipples are
trashed.
They might be cracked, bleeding, very painful, and it can be a
(05:28):
friction barrier that littlesilicone can go over.
The baby can still latch, be atthe breast and feed while those
nipples are healing, ratherthan have the continued friction
from the baby's mouth.
And then sometimes nippleshields another great tool for
them is a transition tool.
So maybe we have a baby who hashad a whole lot of bottles for
whatever reason.
(05:49):
They've been in the NICU.
We started out with bottles,whatever that might be that
babies kind of get used to again.
They need that back of theirmouth, stimulated, their soft
palate, to keep them sucking andbottles travel straight back
there.
Right Pacifiers go straightback to that spot and keep it
stimulated.
Fingers if the baby's suckingon mom's or dad's finger, that
(06:12):
goes straight back to the spot.
But the breast again needs tobe sucked a little bit back
there and babies are kind ofunreasonable people.
We can't tell them, just suck afew times, that'll get better.
So if we're wanting them tocome off a bottle and go back to
the breast a little more, thatmight be an in-between tool.
So it's kind of a compromisebetween a bottle and purely on
(06:33):
the breast so that nipple shieldcan go back, stimulate that
suck reflex on the back of theirsoft palate and then as baby
grows and gets stronger we cankind of come off of that so that
the baby can take the breastitself and the nipple back there
.
So nipple shields do have somebenefits.
They assist with latch andsuction when babies are
(06:55):
struggling.
They can protect sore nipplesso the mom can continue to
breastfeed rather than to stopor or um pause her breastfeeding
.
They can allow breastfeeding tocontinue instead of switching
to bottle or formula if we're indanger of that happening, say
with a tongue tie or something,um, and they can be really great
for NICU or preemie in thatcontext to promote milk transfer
(07:18):
and have the baby eating at thebreast even if it's not totally
eating at the breast.
A nipple shield a lot of timeswe'll use them to if we're using
an SNS or a supplementalnursing system.
Maybe we have pumped colostrumor milk that we're putting
through this tiny tube where wehave formula and that nipple
shield can be kind of astabilizer for that little tube,
whether we put it in the frontor the back of that.
(07:40):
That can help.
So baby's still at the breastbut they're having a little bit
of extra help from a couple ofcontractions and sorry
contraptions and we're gettingbreast stimulation.
At the same time the baby'sbeing fed.
So a lot of times this iswaiting for the milk to come in,
of course.
So some drawbacks to using umnipple shields it can reduce
(08:02):
milk transfer some kindsometimes and reduce supply.
So baby might not get as muchmilk um, sometimes they get more
if they're not getting any atall, but they might not get as
much with a nipple shield asthey are, as they might with
just on the breast.
Um, sometimes it is morepainful for the mom to use a
nipple shield Not always forsure.
(08:24):
I'd say.
The vast majority of the timethe nipple shield's more
comfortable, especially with asore nipple.
But sometimes it's more painfulto use that shield.
Sometimes it gives babies alittle crutch some like latch
dependency.
They become reliant on thatshield and they may not want to
breastfeed, and we'll talk in amoment how to wean off of a
breast or a nipple shield.
It does reduce skin to skincontact, right.
(08:46):
So some nipple shields,depending on the brand, have a
little notch cut out for thenose so the baby can still smell
.
You know the Montgomery glandsand what they're doing but it
does reduce some skin to skincontact right in the baby's
mouth and can inhibit somehormone feedback loops.
However, we can have a lot ofother skin-to-skin going on with
the rest of the mom's breastbody and the baby's body as well
(09:09):
.
This is something to clean,right.
It's something to keep track of, something that needs cleaning.
So we want to make sure it'scleaned properly, rinsed very
frequently, cleaned with soapand water a couple times a day,
depending on how often you'reusing it.
A lot of these nipple shieldsare clear silicone.
They get lost in bed sheetsreally easily.
If you're washing them in soapywater they disappear.
(09:31):
So I often suggest to myclients to put a line of Sharpie
like a permanent marker on theedge of that so that you can
kind of see it.
It's easier to keep track ofthat way.
Some people are worried aboutweaning off of the nipple shield
.
That might be a hesitancy touse that shield, but I have seen
(09:52):
in many cases where it makesall the difference and we can
continue breastfeeding.
So with nipple shields, again Ilove them.
Well, I love them temporarily.
So I like them to always be atemporary tool.
And when you go to use a nippleshield and hopefully you're
working with someone to help youhave a weaning plan from the
(10:13):
get-go.
Like be ready to not use thistool sometime.
Um, sometimes, right afterbreastfeeding with a shield, we
might want to pump a little bitjust to maintain that supply,
because the baby might again,you know, it's just kind of a
barrier between mom and baby andmight not stimulate the breast
as well and then try it without.
Just as you try to look atweaning, sometimes you can use
(10:36):
the motivation of being hangryfor that baby to latch just
latch on to the back for a deeplatch, for efficient milk
removal, for minimum, you know,discomfort for anyone, for mom
or baby.
And clean shields like rinsethem after each use, wash them a
few times a day, depending onhow long you're using them.
Some people will have a coupleof them around the house,
(10:56):
wherever it is.
They kind of have their littlebreastfeeding stations.
So, just to wrap it up, shieldscan be a helpful tool,
sometimes a vital tool,especially in early or
challenging situations, right,depending on what we've going on
.
But make sure you kind ofmonitor the use of that, seek
professional guidance, as you'rejust considering, like you know
(11:19):
, work with an IBCLC, as you'reconsidering a shield or kind of
winning off a shield.
So the nipple shields come insizes between 16 millimeters to
24 millimeters.
The hospitals I work at haveand I think it's pretty standard
16, 20, and 24 millimeters.
We always start with 20.
Like, we'll just kind of startwith a 20 millimeter, unless we
(11:41):
have a really tiny baby.
Say we have a five pounder, ababy in the NICU or something
we'll do.
The 16.
Very rarely are we'll do.
The 16, very rarely are wegoing to do the 24 millimeter
one?
Um, if we have a pretty largeyou know lga, pretty large baby
or very large nipples, again,nipples come in sizes between
like 10 and 30 millimeters.
Um, but with the nipple shieldor that that just covers the
(12:05):
nipple, we're not as um, wedon't have to be.
The nipple shield that justcovers the nipple were not, as
we don't have to be as accurateas we would say with a flange
fitting.
But I have worked with, I'veworked with a mom who had very
large nipples they were some ofthe largest that you'll see with
30 millimeters across, which isabout an inch, and she had a
four pound baby.
So that was tricky and we did alot of pumping when we were
(12:28):
able to.
We had to use the nipple shieldfor a little while for that
baby to kind of learn tobreastfeed.
So, again, a temporary tool, butrealize that it is a tool
Rather than ending abreastfeeding journey.
Hopefully you can use tools tocontinue it and to get it to a
spot where you want it to be.
You can use tools to continueit and to get it to a spot where
(12:50):
you want it to be.
So thanks so much for beingwith us here today.
Hopefully this may haveanswered some questions that
you've had or given you somethoughts or ideas on how to
improve or enhance yourbreastfeeding journey.
Nipple shield could be a greattool.
Usually, it's a very temporarytool.
Hope you keep that in mind asyou go about your breastfeeding
journey.
We wish the very best for youand if there's anything we can
(13:15):
do to help, please feel free toreach out.
You can find us atbirthlearningcom and we'd love
to help you on your pregnancy orbreastfeeding journey.
This is Angie Rozier, withOrdinary Doula Podcast signing
off and, as always, go out andmake a great human connection
today.
See you next time.
Speaker 1 (13:46):
Thank you for listening to the Ordinary Doula
podcast with Angie Rosier,hosted by Birth Learning.
Episode credits will be in theshow notes Tune in next time as
we continue to explore the manyaspects of giving birth.
Thank you.
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