I think as far as colostrum transferring through a shield, what I said and what was discussed earlier, is that it is questionable as to how well the average infant can transfer colostrum through it.  And there has been very little research on milk transfer through shields at all and more specifically with colostrum. It was discussed in an earlier thread that no one had seen any specific research on how well an infant tranfers colostrum through a shield. If anyone has seen any, let us know. Sometimes some women do okay with a shield given on the first day, but IMHO it's more the exception rather than the rule and it usually tends to be the women with a large amount of colostrum. Most of the time I see large weight losses, jaundice and low milk supply problems. Anyway, I do second what was said earlier as to how many women are not even taught how to put them on properly. That's a big problem and so is the problem that they are not fitted properly either.  I find that scenario is more common when they are given by an untrained RN rather than an LC who is trained in their use. So maybe it's a good idea to have a policy that only an LC can start one?
 Yes, pouring honey through a shield is not scientific. Colostrum doesn't usually pour out of a breast like honey out of a bottle. The breast needs to be compressed and stimulated which is more difficult through a piece of plastic, it's especially concerning with what we now know about the importance of skin to skin contact in milk production. What I'm saying is that I think that if we switch from giving a nipple shield during the first 24 hours to recommending spoon feeding of hand expressed colostrum, statistically you will likely see an increased rate of success among your patients.Many, if not most babies who are having latching difficulties will latch within that first 24 hours with a little time and patience.  At least I think we should be providing hand expression as an option to parents. Yes, I've seen colostrum in the shield sometimes, but that doesn't mean that they are getting enough or that mom's milk supply is receiving the same stimulation. I was specifically talking about shields being used so frequently prior to mature milk production, too, which I think introduces it's own set of problems. Studies do show that once mothers begin using any artificial nipple their chances of breastfeeding success long-term begin to drop. So basically I was wondering about the feasibility of introducing a policy banning their use in the first 24 hours. Some people wrote back and said yes, they do have that policy at their hospital and it sounds like a good idea to me. I'm going to try to get a similar policy passed where I work. It's not "negativity" about nipple shields, it's about using them in the best way to provide the best care for patients. I like many of the ideas that were brought up in this thread, such as requiring pre and post-weight feeds and starting the mother with a breast pump any time that a shield is started. It makes sense to me. I certainly can't see a downside of switching from nipple shields to hand expression and spoon feeding of colostrum during the first 48 hours if the mother is willing to do it.

Tricia Shamblin, RN, IBCLC

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