Paula Tripp asked about cutting pieces away gradually from nipple shields.
This is a suggestion that is often used, but I so far have never found out
personally from mothers if this method worked. Warnings I have heard are 1)
she needs to do the cutting away very, very gradually, eg start by just
joining up 2 holes. Somewhere along the line the mum usually cuts off too
much, and she needs to make sure she has an extra one available if baby
won't attach to the cut one, and 2) there is the potential for ulcers to
form in the baby's mouth from rubbing on the cut surface of plastic.

2 days is not very long for the mum to use the shield. She has no need to
panic just yet! (as long as baby is attaching well on the shield and
getting plenty of milk through it) If she can just keep trying without the
shield at the start of each feed, or perhaps at the end of feeds for
comfort sucking, or when baby is sleepy, etc hopefully he will come round.
It depends also on the reason for non-attachment in the first place. In my
experience, this sort of approach usually works, but may take up to a few
weeks.

I know lots of people are very frightened of using nipple shields, and they
have certainly had lots of bad press in the past, but I feel the main
problem was often that the baby "bottle-sucked" on the end and didn't
actually milk the sinuses properly, so that the supply would dwindle. This
is why I am so careful to always check that the baby is attaching properly
and milking the breast efficiently when on a shield. If this is the case,
the supply should not suffer. I still feel that they have a place with
babies that cannot or will not attach to the bare breast, but the mother
needs close follow-up. I still think they are a better option than
expressing and feeding the milk to the baby by other means. Just my humble
opinion.

Joy Anderson IBCLC
Perth, Western Australia
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