The lactation consultant who gave the mom a shield may have seen a
"different mother" than the one the LC saw after discharge.  Some moms
who can't handle the frustration, are exhausted from labor, getting lots
of different messages, etc. in the hospital may only be able to deal
with bottles and shields, especially if doctors and hospitals are not
100% supportive of other measures.  A day or two later, the mother may
be ready for more creative solutions.

A nipple shield has been the short-term solution in one or two cases of
short tongues I have seen.

With regarding to supplementing with a bottle, I have often found that
giving a small amount of formula (up to half the usual feeding) before
the breastfeeding often works better than giving it before the feeding
if mom's supply is low and baby is really hungry.  Chele Marmet and/or
Ellen Shell drilled it into us at my lactation educator's course that
"Babies don't learn well when they are hungry."  I have found this to be
true.  When the baby is only a little hungry, he is more willing to suck
at a breast which he has found to be less than dependable for whatever
reason.  For a baby who has become accustomed to bottles, I often keep
the bottle handy and give a few sips now and then throughout the feed
when baby becomes frustrated.  It often helps calm the mother as much as
it does the baby.  As baby learns that milk comes from the breast and as
mom's milk supply increases (or as she uses a supplementer), the bottle
becomes unnecessary.  If baby won't suck even with flow and a partially
satisfied hunger, I usually use a shield for part of a feeding, or a
feeding or two, sometimes longer.

Shields and bottles are tools.  They need to be used appropriately, but
sometimes they work well in the overall plan for getting baby feeding
effectively at the breast.

--
Bonnie Jones, RN, ICCE, IBCLC from the sunny S.W. USA
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