I have read with interest the discussion of nipple eversion devices.
Our institution will not let us use syringes; they feel we incur some
liability in using a device for something for which it was not
intended :<  We currently use M.....A shells and a manual pump.  I
have very little success in seeing eversions in the hospital setting.
Most of these moms leave pumping to sustain lactation, wearing shells,
offering the breast, then feeding with an alternate feeding method.
Most also leave with an appointment to be followed by our hospital
based outpatient LC service.  Often these appointments are not kept.
Of the ones that do keep the 5 day post birth appt, we often use
nipple shields to acheive a latch.

My reading of the BMJ study of Hoffman exercises and shells being
ineffective also gave me red flags about the potential harm we are
doing in given shells.  The results of this study were that there was
a significance difference in the duration of breast feeding at 6 weeks
between the mom's using shells and the ones without; the moms using
shells were less likely to be bf at 6 weeks.

My questions:
        1.  Are syringes more effective at everting than manual pumps?
        2.      Does anyone go to using a shield (silicone type) right in the
                hospital with notification of pediatrican and strict f/u
                instructions re weight. (We had used shields in the hospital
                but quit when we were getting such poor compliance with f/u).
        3.      If a mom is using a shield and being f/u by pediatrician,
                does she need to be f/u by a LC also.  ( Many of my clients
                balk at the double expense.)
        4.  How are you getting these babes to latch with an inverted
                nipples, if you cannot get the nipple to evert? I see a rare
                babe that will, but these are really a vexing problem for me.

TIA and Best Regards,
------------------
Glenda Deahl, RNC, ICCE