Fellow Lactneters, Does anyone have a hospital policy for Nipple shield
use? I looked in the archives and have a lot of information from the JHL
articles, but really wanted to find a policy or protocol that others are
using and couldn't find any in my searches.  Specifically, at the
hospital I work, only the LC gives out a nipple shield when needed, they
are not available on the unit for staff to give to moms. Therefore the
patient would have an LC consult first. We use nipple shields only if
other methods have been tried, based on the situation.  

 

Recently, again, staff are requesting nipple shields be available for
staff to give. We did a trial of making a few to see how well staff
would correctly utilize them and report any mom's that had been given a
shield to the LC for follow up. Also, the packet given with the shield
included a consent form, along with a feeding plan that included pumping
after feedings and scheduled appointment with an LC for follow up
feeding assessment. All of the shields "walked out on their own" ! Not
one was even documented in any patient chart and no one that worked on
the 4-5 days that shields were available admitted to having used one or
given any to a patient. We had to find out when making our routine
follow up calls after discharge and it was very frustrating and so that
ended that subject for a few months. . 

 

 My argument is and has always been that I do not feel staff should make
that call, if a mom is having trouble getting an infant to latch then
they should have an LC consult first. For added interest, below is some
of the correspondence regarding this between myself and one of our staff
nurses  (she is on our employee voice committee) 

Thanks for any correspondence, you are welcome to email me privately
also.

Pam Price IBCLC

Trident Health System

Charleston SC 29406 USA

 

This is the email from the staff nurse:

"Pam thanks for forwarding this length note.  Mine will be short.  The
nipple shields need to be available 24hrs a day 7 days a week.  You, not
replacing them, are not helping moms that need them in the future.  This
is not their fault. 

Please make them available ASAP."

 

 

This was my email to her that prompted that response:

  XXXX  gave me a report on the issues discussed at the staff advisory
meeting this morning. I wanted to address the issue of the nipple
shields. I am forwarding the 3 MOXs that refer to the nipple shields and
the trial that we did with them on the unit. It is an enormous liability
to use nipple shields, they are a barrier and usually not the answer to
feeding or latching issues. Patients using nipple shields must have
outpatient follow up for as long as they are using the nipple shield.
When we did trial making them available to staff, the shields
disappeared. No staff claimed to have given any out, and I even went
through each and every patients chart to see who had gotten them but it
was not documented.

 

Many hospitals do not even allow the use of shields due to the
liability. They are most helpful with premie babies who have difficulty
maintaining a good latch for an adequate feeding.  Often times mom's
with flat nipples do better with out a nipple shield, positioning
correctly at the breast can make a HUGE difference in the infant's
ability to latch well. 

 

If an infant is having difficulty latching and is hungry, then have mom
hand express some colostrum and feed the baby the expressed colostrum.
Give the baby another hour or two with mom, then arouse infant and
attempt latching again. If infant still is not able to latch well,
repeat the process but in addition to hand expression, have mom pump
with the electric breast pump to stimulate production.  Often after a
few close feedings of expressed breast milk, infant will be more
coordinated and better able to latch. 

 

The LATCH inservice will be very helpful for those staff that have
difficulty assisting mom's with latching, we review the same techniques
that we have been teaching to patients and staff, also the When Latching
guide in the breastfeeding packet has a step by step guide to latching
and positioning.  

 

Thanks for being part of the staff advisory committee."   


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