I love it, "oroboobular disproportion", can i use it?

Denise MSN, RNC, CLC (sitting for IBCLC in July 2010)




Date:    Wed, 12 May 2010 00:48:19 -0400
From:    Charity <[log in to unmask]>
Subject: Many Thanks and Nipple shields

Many thanks for all of you who took the time to e-mail be at my regular address for suggestions on wording a donor milk Rx.  I love Lactnet!!

My ten cents on nipple shields.  I tend to size them to the baby's anatomy.  The best research we have for use is with preemie populations- and those babies need the breast to be sized for them or we have a whole lotta oroboobular disproportion. Of course there is a balance, but that is where I start.  I also canot start a mom with a nipple shield and not worry about milk supply.  It is a barrier- some kinds are transferring more milk, but some are transferring less.  How do i know who is who??  I don't unless i also have every mom with a nipple shield do test weights.  Plus it works best for populations that are moving the least amount of milk- oral anatomy problems, preemies, small near terms.  These are the kids who are already having trouble moving milk.  These moms should be insurance pumping at least a couple of times a day.

I am very concerned with nipple shield use in my area of the world (San Francisco).  Both of our big birthing hospitals are sending a huge percentage of mothers at our practice home with one.  The diagnosis?  Flat nipples.  Really?? every mom in our practice has flat nipples?  

I have used them for a number of situations (usually preemies, small near termers, and oral anatomy issues).  I have used them for flow problems with babies with boarderline tongue tie- (they nurse ok, but cannot handle niagra falls).  I cannot remember a time when I have not had some position (I can get very creative) or breast compression (tea cup hold, nipple sandwich etc) work for a "flat nipple" provided the breast tissue is adequately malleable.  If the nipple is super flat- but the breast is squishy, a tea cup hold usually helps.   If the breast is hard- well then we need to be moving some milk- hand expression, RPS, massage, however you get the milk moving and the nipple soft- we should be doing it.

I worked postpartum as a nurse.  I know the grind. I know Nurses are rounding on 5-6 mother baby couples in the first two hours of a shift.  I know a lot of the kids are drugged to the eyeballs, and most moms have pitting edema (or they did where I worked in VA).  But I cannot get past the "follow question"- if I plunk a nipple shield on this mom _who is following up_?  Who is checking the latch?? Who is re-evaluating when the milk comes in??  Who is checking up on milk supply?? who is weaning this kid off of the shield after three weeks of a hyperstimulus??  For most moms the answer is no one.  And that is not a great situation to stick a piece of silicone. 


Frustrated in the Bay Area.

Charity

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