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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