Re the mom with Hodgkins,

I wonder if perhaps she could slow down her production on one side, by just not nursing and only pumping to comfort on that side for a few days to a week, until it is almost nothing, while continuing to pump well and regularly on the other side. Then she could nurse with the nipple shield and SNS on the "dryer" side, while maintaining enough
of a supply on the other side to provide the basis for relactating when she's done with chemo.. Of course that nursing on the nipple shield could start rebuilding supply again on that side, but quite slowly if as you say most of the child's nutrition is thru bottles, and she only nursed on that "dry" side, say, a couple times a day, and
offered a relatively fast flowing SNS with it when she did, the amount of increase would be minimal. If she did notice that she was getting more than drops of milk, she could cut back on the nursing for a day or two, only offering the breast for a brief time, or not at all, if that is possible, for a couple days to slow production back down.

Plugging the hole on the nipple shield could be problematic if you plug it with anything that has a chance of getting loose, if the nipple shield fell off, baby grabbed on again, I've thought of that malleable silicone that is used for homefit custom fit earplugs for example, but I'd be worried about some odd moment when suddenly the baby
somehow accidentally turns the shield inside out, and latch on again and could choke on the stuff. Not likely, but that's what accidents are, things you don't expect. She could probably plug the nipple shield simply with tape on the inside of it,  if that would not pose the same issue? With tape the SNS would have to be used on the outside of
the shield, I guess that would work.

Maybe a better solution would simply be to contact Medela or Hollister and see if for goodwill purposes they would make a few for her that have no holes?

In any event it seems to me that she would have to slow production, even if she can figure out a safe way to plug the holes, because otherwise, when the baby nurses, the nipple shield will fill with milk and be incredibly messy, fall off, etc.

I think if she slows production down on one side, the amount of chemo the baby could possibly get, even without plugging the shield, would be inconsequential, although I would probably check to see what Dr. Hale's opinion is on this. A nipple shield with no holes and slowing production on one side would seem to solve any problem there.

Tina Smillie, MD

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