Hi Marie,

I am also a lactation consultant in a hospital.  I understand your
dilemma.  When I first started working in this setting, the nipple
shields were locked up and it was a big production for a patient to get
one.  I was not a fan of this process.  First of all, there are some
very good nurses who know when and when not to use a shield.  Secondly,
if a nurse has not used a shield appropriately, then I educate her.
Taking the access to the shields away seems punitive, and I'd rather
educate.  If a nurse uses a breastpump inappropriately for example, I
educate her, I don't lock up the breastpumps. We are also fortunate to
have our patients seen by an IBCLC each day.  So if a shield is given
out and not really needed, we can have mom discontinue using it, and
show her another way.  
We make every effort to not over-use shields and to always use them
appropriately and with specific follow up.  We did a survey of about 25
moms that went home using shields and about 95% of them said the shield
helped them and they probably would not be nursing if it hadn't been for
the shield. 
Educating the staff about early and frequent access to the breast, as
well as hand expression of colostrum to a spoon has helped eliminate
early introduction of the shield as well.
Hope this helps, and best wishes with your work.  

Mary
PS: I was also at the Log Cabin conference.  Great information!  Thank
you Catherine, Linda and Dr. V.

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