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Date: | Thu, 6 Apr 2006 11:03:13 EDT |
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Just read postings on the nipple shield. Yesterday our unit neo (we have one
exclusively for Mother Baby Monday thru Friday 8-5 and weekends and holidays
we share with NICU), asked me to see a patient who had "flat nipples" she
asked me to give her a "nipple shield". I immediately corrected her in front of
everyone and said, "Let me see if she needs shells, she definitely doesn't
need a shield yet." It was an opportunity to educate and reeducate everyone
within ear shot. I explained to her that a shield is not preferred and why
we avoid them at all costs. She was very excited to know the logic behind the
comment. Once we got her on board...it was great.
This Mom had soft nipples that over time would become more erect with her
big boy's efforts....unfortunately he was zonked out because he had been circed
and was what I like to refer to as hibernating for 4-6 hours after the
procedure. I gave her shells to help and boost her confidence and then gave her
the numbers to follow up with outside LCs after discharge today. She had
fortunately nursed directly after the circ was done so the baby had sometime to do
his thing. I gave her the "reboot the baby" skin to skin concept we learned
in Chicago and left her for 30 minutes. I also gave her a hand pump to help
elongate the nipples if necessary.
I had a new orientee with me so I was able to teach the shield/shell
confusion and give her a leg up (she came from Med-Surg) and she embraced it and
took all our literature home to study.
Later went back to check on patient. She had embraced her baby skin to
skin but when he didn't want to nurse she impatiently gave one ounce of formula.
So what did we learn from this little time....if you don't stay with the
mom at the bedside you might have her giving formula....but when you have 5
patients and no one dedicated LC to stay at the bedside for an hour....you know
you gave your best. Mom verbalized she understood but she felt her baby was
starving...he hadn't eaten in nearly 5 hours....he wasn't crying he was zoned
out on her nice soft warm breasts. We will never know if he would have
awakened to latch. Am off today so have way to see if he is doing well...will
check with his nurse later today.
I am for taking the shields out of the Omicell and having them only in the
Pyxsis so we can track who gave by the sign out....Pharmacy won't allow it. So
for the time being I am trying to get a sign in the omicell that reads "Must
have LC evaluate patient prior to dispensing of any shield".
I guess its time for another inservice. Does any one have breastfeeding
included in their unit mandatories?
Really enjoying a beautiful springtime in Miami, wish you could share.
Leanne Jewell RNC, IBCLC, LCCE, FACCE
SFl
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