Karleen sounds like I did before I saw how the nipple shield worked on premies. My former supervisors had me scared to death of using them and I was always admonished that the baby might not transfer enough milk. We always used an SNS,which in many cases was inappropriate. What a nice surprise I used a nipple shield for a premie and it worked. I don't use them often, but I have a better sense of when and how they work. Knowing how to use a tool appropriately is important to avoid overusing it or not using it at all when it would be helpful. What helped me learn about appropriate use of the nipple shield was observation and discussion with my colleagues. Karleen - if you ever make it here, I would love to have you come to our support groups to observe and even talk to some of my former clients. Observation can make a huge difference. All of your qualms I think come from the possibility of inappropriate use of the SNS. With careful management, I have lots of cases where they have gotten off the SNS. It happens all the time. Babies don't HAVE to get used to the SNS. In most cases with a good latch, I think what babies notice is the flow, not the tube itself. So, if they get used to a fast flow from anything (SNS + breast, bottle, fingerfeeding, cupfeeding) then they are going to continue to expect a fast flow. YES, I can see how the SNS can work in a way that is similar to the rat study you described. If the bottle were placed high - the tube was placed downward on the breast, or a too rapid flow, the baby would indeed have no control over flow. That can be just as harmful as using a bottle inappropriately. What I have found happens when a mother has an abundant milk supply and uses the SNS is that the baby comes off choking, clamps, retracts the tongue. I have less often seen that the baby won't take milk. I alwasy have women watch for this and call when it happens. That's when we up the breast alone time - drop tube sizes - or sometimes even drop the SNS below waist level, depending on the particular case. Or, in some cases with a mom who has a rapid milk ejection reflex - I use other strategies. For premies with a mom with a rapid milk ejection reflex, the nipple shield can sometimes work like a charm. I find it really helpful to always check for milk transfer from the breast while using the SNS. So, yes Karleen, I have documented where a baby is taking next to nothing from the SNS. I swear it happens, because I've measured it. But I want to make it clear, that we do everything to avoid combining a rapid flow from the mother with a rapid flow from the SNS. That's not helpful. When a baby is capable of sucking effectively initially that then gets tired on the breast, we start breast alone, use breast compressions, switch breasts, and then add the supplementer when the baby is still hungry but can't help the mother release milk anymore. I have a whole study designed for looking at tube placement and venting and I think this type of study should really be done. It would confirm all of our individual observations about how best to use supplemental devices - or refute them. We're trying to rebuild our practice after Elizabeth Seton closed and I have a small son, so I don't have time to do it yet, but I'm working on my former colleagues at Cornell, and anyone who is interested and won't forget about this until someone eventually does a well-designed study. A separate study should be done on different supplemental devices. As I mentioned before, I was amazed when I discovered through the very large Elizabeth Seton breastfeeding support group that some women were able to get out of a low supply, inappropraite suck with an Avent bottle (which seems pretty quick to me) and a pump. I think patience and diligence will win out with many different strategies. What we need to figure out is what is the fastest strategy for each of the many different situations we encounter. The reason why I don't use the Lactaid initially is simply because it is difficult for women to assemble. Once they get the assembly, they often do like it better. For clients who are just starting to use a supplemental device at the breast, having to cope with tricky assembly may be just the thing that causes them to give up. Even the SNS is tricky. So, for very young infants - I often start with a simple syringe and tube that we provide free. If the woman can handle that, and the baby needs longer term assistance, then we switch over to the SNS. If they can't handle the tube on the breast, we try other strategies. If it is an adoptive mom - then I talk about the Lactaid right away. The SNS and all the other similar devices are not evils that keeps moms from bonding with their babies and babies from learning how to breastfeed. It is simply a tool that can be helpful when used appropriately and interfere when used inappropriately. AND finally, I have to pipe up about our visions of the NOBLE SAVAGE!!! That somewhere or sometime in the past, there was breastfeeding perfection. I have lived and worked in many different developing countries. I can guarantee that there is no breastfeeding utopia. They use different tools to solve breastfeeding problems than we use, but they are not problem free. Just to give one example, the "pump" that is used in some cultures is an "older child". The "supplement" is another mother that has fully established lacatation. The older child (pump) relieves the engorgement, the newborn goes to another fully lactating mom (supplement) and this is how the problem is fixed. Also the mortality rates in many of these countries are extremely high - so there is a lot that is hidden and undetected in those mortality rates. I am sure that there are some babies that die because they have significant problems with their suck and end up underfeeding. I still remember conversations with mothers that, in retrospect, suggest to me that there was something real going on that interfered with their babies driving the supply. Someday I also dream of going back to my work in developing countries and reexamining some of these problems. Best, Susan Burger *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html