Nikki mentioned that someone published the "concept" of using pre/post feed weights with nipple shields to monitor milk transfer.  I don't know about elsewhere, but here in Manhattan and much of Brooklyn, the vast majority of solo out of the hospital IBCLC practitioners have been doing that for years.  I've been doing it for eight years.  I wouldn't dream of using a shield without assessing whether the nipple shield improves transfer or not.  In fact, I have seen and posted about differences in milk transfer with the size of the shield.  The most dramatic difference was a baby that took 1 hour to transfer 1 oz with a 16 mm nipple shield and 10 minutes (after the 1 hour) to transfer 2 oz with a 24 mm nipple shield.

In fact, the use of test weighing to assess the pros and cons of nipple shield use in my area, that it didn't even dawn on me that others weren't doing this.  Otherwise, I most certainly would have conducted some sort of a study and published it.  And yes we do know what mothers would be at risk of low milk supply.  Those mother's who have babies who can't transfer an adequate amount of milk even with the shield.  

I find among the full term babies who I find most benefit from the use of the nipple shield are those who cannot grasp the areola well with their lips.  They slip and slide.  The nipple shield seems to act like a mat you put out on wet or icy steps to stop people from slipping.  This sometimes occurs temporarily when mother's breasts are very engorged (because someone in the hospital told them to supplement but forgot to tell them to express milk). Then it usually is only a matter of teaching the mother to sandwich the breast to progress off the shield onto the breast and then even the sandwich goes away.  In other cases, the baby may not have the muscle tone or feeding stamina for a while and it requires more work.  In some cases the breasts may be highly elastic and that may take even longer or, if the mother doesn't give a hoot, she may just be perfectly fine with using the shield.  

The problem with use in the hospital is that the breasts are in such a rapid state of change that they look entirely different by the time I see the moms than what the mothers were told their breasts look like in the hospital.  To date, I know of no baby who was ever assessed for milk transfer with a pre and postfeeding weight check in the hospital and I'm not sure it would be helpful anyway since they are drinking so little at that time and since babies change so rapidly day to day in the first few days.  Personally, I would rather work with a baby that has not been given a shield in the hospital.  

Best, Susan Burger

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