Susan the problem with nipple shields IMHO are four-fold: 1. They're prescribed by someone whose skills are poor and who doesn't know what else to do. Policy suggestion: nipple shield usage to only be initiated by IBCLC 2. A lot of baby/nipple mixes don't 'fit' any of the available nipple shields, therefore the shield is more a hindrance than a help. Policy suggestion as above. 3. Many mothers still are unable to latch the baby correctly, ie. with bottom gum far enough down on breast to be compressing the lactiferous sinuses. Policy suggestion as per #1 and must have followup every feed until mother competent with latching. 4. The shield interferes with milk transfer and also stimulation of breast to continue milk production. Policy suggestion: monitor milk intake of baby by monitoring output in the first instance and weight in the second. Only treat as low supply (with pumping, etc) if a documented low supply exists. Therefore, mother and baby will need at least weekly followup initially and continue followup whilever shield is being used. That there is milk in the shield before, during or after feeding is irrelevant - all that shows is that she may be leaking a little milk, not that the baby is getting a good breastfeed. Nipple shields really push a few buttons with me. I know there are cases where they have been very successfully used and are the ONLY way that mother would ever have been able to breastfeed, but surely these cases are very few and far between. The majority of times I see them used are when the midwife assisting the mother hasn't got a clue on how to latch the baby (or teach the mother to) and so they grab a shield - the baby sucks something, rarely enough of the breast, and they hand-over that the baby is now feeding well and must be getting something because there was milk in the shield. Then I get shot a very defiant look!! :-( Basically I would like to see nipple shield policy note that they are an intervention which could cause serious problems for both mother and baby and therefore are only to be prescribed by qualified personnel and the mother and baby must have continuing followup until the intervention is no longer needed. (OK Climbing slowly down off my soapbox) Denise **************************************************** Denise Fisher, BN, RM, IBCLC BreastEd Online Lactation Studies Course http://www.breasted.com.au mailto:[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(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html