"...but starting it in the hospital..."

Yes, sometimes I did.   (Dare I share???)

- Mom's nipples were very inverted, she was not "dedicated" to
breastfeeding.  Unless she felt she could put the baby to the breast "right
now" she would be bottle feeding in the next 30 minutes.

After the mom saw the baby had in fact fed at the breast, she changed to a
more willing participant in the activities that would lead to
breastfeeding.  We used the nipple shield to get the breast into a more
"nipple shaped" (no, the nipple did not come out then, but at least the
breast tissue formed into the shield and we could take it off and put baby
on).  Yes, a pump would have helped IF I had had a pump nearby.  Yes, hand
expression and putting milk inot a spoon or cup would have helped - but
this mom was not interested in spoon-feeding her baby.  she either wanted
to breastfeed or forget it!  Once she saw baby could latch on and
breastfeed, she was willing to try things like pumping after feeds and we
were able to have exclusive (no nipple shield)  breastfeeding in 5 days.

- Mom's nipples were terribly damaged due to incorrect positioning - only
12 hours after birth.  Again - a bottle of formula was in her hand, but
when I showed her that with the shield it was not so terribly painful - (I
had tried correct positioning but the pain was too great.)  After using it
for 2 days - never needed it again.

- baby with tongue-tie.  Mom's nipple damaged very badly.  Able to
breastfeed with the shield (colosturm and milk came in, baby well nourished
despite use of nipple shield)  through the weekend - when MD was able to
cut the frenulum.  Never needed it again!
(Again, pumping and/or hand expression would have been an alternative, but
this mom wanted to have nothing to do with it.)

Linda Smith's "rule" The mother is always right - means to me, that the
mother knows what she can or cannot cope with at this time.  We can
cheerlead her, but we cannot force her to do something.  My job is to give
her a list of alternatives with their risks and benefits and assist her in
doing what she chooses to do.  To NOT use a nipple shield in any of these
three cases would have meant a non-breastfed baby.  All three breastfed for
over 6 months (I lost touch with them after that - don't know how much
longer they did feed.)

[This is one of the examples where I ask others to understand that "never"
or "this is not appropriate" can scare people off from sharing their
experiences.  Experiences which can be useful to learn about!]

Jeanette Panchula, BSW, RN, IBCLC
Vacaville, CA
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