Margaret,
You ask "do you teach the mom to evert the nipple before fitting on the
shield? What if the nipple will not stay in the shield shank? What constitutes
properly placed shield in that case?
My response to your questions are 1.) No, I don't teach mom to fiddle with
her nipple to get it to stand everted. I feel this sends a message to the mom
that her body has failed her; as though she doesn't have the "perfect" body to
instill in her the ability to breastfeed. I've seen some moms grabbing at
their nipples, pulling, prodding, pushing at their chests....none of them appear
confident nor happy when they start to do this. I also don't teach that mom
needs a pump to evert her nipples. Mom can use her hands to gently massage her
breasts prior to placing the shield, and usually a flat nipple or slightly
inverted nipple will protrude more firmly from the base.
2.) When turning the shield inside-out prior to placement on the nipple, the
"suction" everts the nipple so that it lies within the shaft of the shield.
Usually there is no problem with this working, but occasionally, I've had the
shield firmly adhere to the nipple without the nipple extending into the shaft
adequately. In this event, I usually proceed to achieving an asymmetrical,
deep latch and thence, use baby's compression at breast to further extend the
nipple into the shield. I wait until baby naturally comes off of the breast,
and then I show mom how her nipple is extended within the shaft of the shield.
It is back to basics...a proper latch that causes the nipple to be in proper
placement within the shield.
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL
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