"Last week, unbeknownst to me a patient was given an orthodontic nipple to
try as a
shield by a nursing instructor (at that time) who works as a midwife
elswhere, and says
they use them "all the time" with great results. "

I'm sure the great result she is talking about is that the babies "latch"
onto the orthodontic nipple.    I would question her about milk transfer and
her follow up of these mothers.   My guess is that a mother using an
orthodontic nipple as a shield will either quickly come to the conclusion
that she doesn't have enough milk and resort to formula or will inadvertantly
 starve her baby.  This midwife most likely does not follow the outcomes with
these mothers and babies. I think it was very wise that you documented this
so carefully. I would also write an incident report because use of a bottle
nipple as a shield does not meet community standard or safe practice and the
risks are pretty high.  Almost any baby will latch on to a bottle  nipple
attached to the breast and almost no baby will get milk this way.  So many
nurses think that latch is the beginning and end of a bfdg assessment. They
need to be taught to look for signs of milk transfer--audible swallowing,
breast softening, etc.  I use bottle feeding as my analogy--i.e. if a baby
latches onto the bottle nipple and sucks and sucks but no fluid ever leaves
the bottle, is he feeding well?  They get this.  I also explain if you put a
bottle nipple over the mother's nipple baby will latch and suck but will get
little or no milk, starving baby and jeopardizing the milk supply. I also
explain that sometimes babies latch well to the breast but there is still
diminished milk transfer and that this can be due to a variety of causes but
all necessitate an evaluation by an LC.

Oh and good luck to all you test takers. I'd tell you not to agonize but have
never been able to follow that advice myself, so have a margarita and have a
ball when it's over.  I know you'll all do fine.

Kathy Boggs, RN, IBCLC

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