Someone wrote: 
If it doesn't work, then I show the mother how to hand express onto a
teaspoon and then feed it to the baby (mothers tend to get discourage
when they see only droplets on a breast shield).   If neither of these
work, then I would consider the use of a nipple shield.  
 
If you or the mom are unable to express a little milk on a spoon ( and
we do see that problem when the breast is edematous, or the mom has had
pitocin during the birth) then how will the baby get any milk from the
beast via the shield??  What frightens me is that these moms are going
home on day 2 with shields with a false sense of security that they are
"breastfeeding" and may continue until either the baby loses too much
weight, or the milk supply is compromised.   I think that follow up is
essential by about day 4.  
How many moms get a re-check when they are using shields?
 
By the way, what looks like milk in the shield is often saliva that has
been sucked out of the baby's mouth.  Not only is the baby not getting
milk, but we are taking his saliva too!!
 
I gave two moms shields yesterday.  
One with a huge baby ( 4K350g) who just did not get the hang of
breastfeeding.  By day 4, he was on bottles, and the mom was told NOT to
pump in order to avoid engorgement ( I am sure that you have all heard
that brilliant piece of advice).  She was nearly exploding.   I did
manage to get the baby on the breast and transferring milk after much
hand expression to relieve the swelling in the areola, and of course
sent the mom to pump to provide an insurance bottle just in case.  I
referred her to an LC out of the hospital to continue the follow up.  
The second mom has those really problematic huge inverted nipples and
her baby just could not get it.  I even had trouble hand expressing milk
for this baby, but we did get enough spoons for the first few days and
she gave a bottle or two of artificial milk..  Pumping was a problem
because we did not have a wide flange available.  I helped mom get the
baby on the shield, and he did not transfer any milk, but was happy to
stay on the breast.  I gave him some artificial milk via tube placed
under the shield and he was annoyed.  I also referred this mom on to a
colleague to continue working with this mom.  
As someone pointed out: each case is individual and we have to treat
each one based on the needs of the mother and baby.  
 
 
Esther Grunis, IBCLC
Lis Maternity Hospital
Tel Aviv, Israel
 

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