Yes most moms do have normal nipples and I agree with your post and Karen Gromada's.
Early in my career, I did not like nipple shields. However, this all changed after being called to the NICU( on numerous occasions) to help a baby latch and" oh by the way he/she's been discharged or being discharged today" and this was the first breastfeed( thankfully this happens less but still occurs). I soon learned that a nipple shield could make the difference between breastfeeding or not breastfeeding. Especially in this vulnerable mother and infant. There are other (as we all know) occasions where a nipple shield can really help. They can also really hurt a situation and a number of considerations must be made which include: thoughtful consideration, informing the mother and having a discussion with her on her goals, weighing the risk benefit ratio, and being skilled at instructing the mom on proper fit and what to look for. I always ask myself " Am I meeting this mother where she is at?" " Will the nipple shield make a difference?"
" Is this a baby who has had bottles from the gitgo?" Evaluation and reevaluating are essential.
What is absolutely crucial to my practice is that I want to be sure that the mom going home breastfeeding with a nipple shield must be instructed on and encouraged to return for a consult or at least to have baby's weight checked and soon. Follow-up is critical here. Another factor is her stage of lactation. I still do not like using nipple shields in the first few days. I sometimes do but tread carefully. Swallow sounds do not equal transfer of milk especially in the primip in the first 3 days. Mother's really should pump if they are using a nipple shield in the early postpartum period and babies should be observed closely for color, quality of feed, behavior, voids, stools and weight changes.
Where I work we have developed as a group of LC's a protocol for nipple shield use. We make every effort to discontinue nipple shield use while still an in patient. Sometimes alls it takes is a couple of good latches and careful management. Sometimes, the next shift rolls around and the baby begins nursing well without the shield or on one breast without it. We recommend to our mother's that they return for visits and if declined, follow up by phone.
Colleen McKeown RN, BSN, IBCLC
Midwest Hosp. Based and Pediatric Office
________________________________
From: Pamela A Hendrix <[log in to unmask]>
To: [log in to unmask]
Sent: Wed, May 12, 2010 5:44:24 PM
Subject: Nipple Shields
At my hospital (and the other 2 in our system) the bedside nurse does NOT have access to just whipping out a nipple shield and using it. They are in the Lactation Consultants office. We use them only when needed. With strict instructions and follow up. Pumping is a must when they are used. We have several Lactation Counselors who work as bediside nurses (and cover sometimes on my days off), 2 IBCLCs that are bedside NICU nurses, myself the fulltime Lactation Consultant, and another educator who is an IBCLC who covers from time to time. They all know the shields are not a first line to help.
Having a nipple shield available for typical bedside nurses to use is a BAD idea. There is so much they need to understand. And the first thing is that MOST MOMS have perfectly normal nipples. Aren't we all kind of tired of hearing the mom has flat (and even inverted) nipples, we walk in the room and we think...what the heck was that nurse thinking?? This mom has perfectly fine nipples! These poor moms, they must be so confused.
Pamela A. Hendrix, BA, RNIV, IBCLC, RLC
S. Florida hospital based
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