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Thu, 6 Apr 2006 21:18:58 -0500 |
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yes--a very interesting discussion!
I personally almost always use a 24mm shield...but I am in an exclusively
out-patient and usually more than 3 day-old baby setting. I rarely have
trouble getting a good amount of nipple into the tip, but I often wonder if
we see a disproportionate number of large-nippled women. (Speaking of
which, I first used the 36mm medela pump flanges yesterday! Had a mom that
complained the 30mm were still not comfortable...got out the 36mm, and the
milk started flowing! She was one of those women who actually looked like
she had small nubbins of nipples, but when started pumping they really got
very wide.)
Anyway, we only have contact shields, so I don't have 20mm. I have never
had a situation where I felt the 16mm worked better, but I know one of my
colleagues has.
Someone mentioned that if the nipple is pulled all of the way into the
shield it should always be comfortable for mom. I respectfully disagree. I
would say that IF the baby is suckling normally, yes, that should be the
case. But I see a LOT of babies who are into "chewing", and continue to do
this on the shield...which hurts. I also see a fair amount of babies who
do not remove milk well with a shield even though mom is more comfortable
and the breast is pulled into the shield. Now remember, I see the worst of
the bad situations...my LCs get to do most of the "easy" ones!!!
Just my 2 cents-
Kathy Leeper, MD, IBCLC
MilkWorks- Lincoln, NE
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