>From: Kathy Boggs <[log in to unmask]>
>Reply-To: Lactation Information and Discussion
><[log in to unmask]>
>To: [log in to unmask]
>Subject: orthodontic nipple as shield
>Date: Tue, 23 Jul 2002 15:05:30 EDT
>
>"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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Thanks for the comments. I think I was most angry that my relationship with
the patient was compromised at that point in time. Perhaps down the line,
one way or the other she will realize that it isn't working and think twice
about what was said. I see the instructor tomorrow and plan on asking more
about her "great idea" and under what circumstances she uses this. Then I'll
pull out Auerbach's original research from the 1980's when we stopped using
them to my knowledge and share evidence based practice with her in as kind a
way as I can.

LuAnn


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