Theresa Klein asked:
> 
> I have a patient that delivered at 32.5 weeks gestation. Baby was 3lbs 
> 12=
>  oz=20
> at birth. Baby is now 4lbs 14oz. Mom is bottle feeding expressed breast 
> m=
> ilk.=20
> She is exclusively pumping. --- She would like to eventually get baby to breast. She is now 36 
> =
> wks=20
> gestation. My question is do you feel that she would go to breast easier 
> =
> with=20
> the use of a nipple shield. I know preemie babies do better with a 
> nipple=
>  shield=20
> to keep the latch. My concern is getting enough milk to her if she does 
> u=
> se=20
> the shield. Please feel free to email me privately if you like. 
> tklein@cm=

Theresa -
What works is what works.  As this baby has never had an oral experience other than a pre-formed object made of silicone or rubber, a *well-fitted* nipple shield is a good option to try.  If you warm and slightly stretch the base of shaft of the shield, more of the breast tissue can drawn in.  If the shield is a thin silicone one, milk transfer should be okay, and you can teach the mother to identify when her baby is drinking, to reassure her.  If there is any doubt, she could hand express or pump 1-2 times per day and store the milk.
Some oral experience at the breast is good, even if the baby isn't ready to latch at something as unfamiliar as flesh just yet.  Perhaps when the baby is sleepy and restful.  Lots of skin to skin, of course, at non-feeding times.
If you use a shield, I find it helps if the mother doesn't have a particular timeline for discontinuing it, but watches her baby's cues and enjoys the experience of having her baby taking milk directly her - without the separation of baby from breast that happens with pumping and bottling.
Keep in touch with her for support.
Virginia
In Brisbane, Queensland  

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