I have had 2 Moms over recent weeks sent home with *small* Medela contact
nipple shields   who had given up on the shield   d/t frustration with use.
Upon exam, both babies were over 6 lbs with average sized mouths and nipples
but refused to feed with small shield. Despite compression and sustained
suckling, milk flow was low and baby would become frustrated and pull off.
This observation is consistent with my experience with the small shields and
because of this, I use them rarely with the population of already Dc'd babies
that I am seeing. I CAN see their place in a NICU setting with a small premie
but am wondering if the flow restriction, seemingly inherent to its use, is
an issue there as well.
Incidentally both babies had been bottle feeding for 3&5 days but moved
happily to the larger shield *once flow was established*.
 Neither of these moms called seeking a consult. They both had pumping
related ?? (although neither rented nor purchased a pump from me!). Both were
bottle fdng EBM and it wasn't until I questioned them further, that the
possible problem was found. Both had consulted with the hospital based LC and
felt that since they had *already seen a lactation specialist*, all had been
done that could possibly be done.   Needless to say, it required much
*convincing* to set up a consult.
To all hospital based LCs- please discourage parents from viewing you as
their last chance to making breastfeeding work. Most parents that I see
haven't absorbed the concept that breasts and babies change from day to day
ie. what doesn't work one day, may the next OR they have no idea that there
can be vast differences in approach/experience etc, between individual LCs.
More often than not, according to them, MY teaching is very different from
the last LC they saw!
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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