On Thu, 4 Dec 2003 20:15:17 EST, [log in to unmask] wrote:

>I'd like to poll the masses of wise women and men here.  When you determine
>that a mom/baby couplet needs to use a nipple shield, do you have her do
any
>insurance pumping?  If so, when, how often, and for how long?  And why?
If not,
>why not?
>
>Just curious.....
>
>Jan Barger, RN, MA, IBCLC, RLC
>Wheaton, Illinois
>www.lactationeducationconsultants.com
>
>             ***********************************************
>
>I use them for several different situations. Including, but not limited to:

ONE, if the mom has very flat, inverted or lack of dicerable nipple *AND*
the baby is unable to form a nipple from the available tissue. We try VERY
hard to teach the baby to do this, before resorting to the shield. I have
seen newborns do fine forming a nipple and hitting the "spot" with totally
inverted nipples and other babies not being able to form a nipple with
slightly flatted nipples.

TWO, if the baby is "addicted" to a less desirable "shield" (like the
bottle nipple case I presented a few months ago) and is *also* unable to
form a nipple from available tissue, or can't get mom's nipple back to
his "S-spot." Esepecailly, if he gets terribly frustrated when being put to
the bare breast. We then try to wean as soon as possible from the shield.
Or if the baby has stubborn nipple preference, and needs some help forming
a nipple until he figues it out. (I also have the mom whip the shield off
during the feed pretty early, and once the baby is on, this usually works
in these situations.)

THREE a preterm baby who just can't get enough tissue into his mouth, keep
it there and milk it well enough to transfer. If the baby has been bottle
fed, and not gagging on the botttle nipple, I still use a 24 mm shield, as
it gets more of mom's tissue into the baby's mouth. I find, if the baby has
been given and handled a regular bottle nipple (and sadly most hospital
STILL insist on this) than a 24mm shield is usually well tolerated. Other
preterm babies do better with the 16 mm shield.

I do pre and post feed weighs with a Medela electronic scale. If transfer
is good, the baby got a good quantity of milk with the trial with the
shield and it is early in the baby's life, there is not always need
for "insurance pumping." (IMO) If it has been a week or more with poor
latch ect, then I leave a pump for at least week. ALL my shield babies get
weighed a few days later, and I do an other pre and post feed weigh, SOON
after giving the mom the shield, and then we weigh at least once or two
times a week. If gain is normal, I don't insist on insurance pumping. (With
preterm babes, though I always insist on insurance pumping. Even by 7 lbs,
a lot of these kids just aren't adequately milking and giving enough
stimulation.)

I always use Medela Sterile Contact Shields (no financial interest in the
product,) almost always the 24mm size, unless mom has a really tiny nipple
or areola, and/or the baby gags easily (due, usually to oral aversion,) and
has a small oral cavity. With the 16mm shield, I feel test weighing is even
more essensial, as is "insurance pumping" until we have determined that the
baby is transfering plenty of milk. If the shield is going to be used long
term, I try to switch the baby to the 24 mm as soon as he can tolerate it.
I feel, most of the time, there is better chance of getting more breast
tissue into the baby's mouth and better transfer.

In a mom with flat, inverted or non discernable nipples, I also wet the
shield (and mom's nipple) with ice, to facilitate whatever eversion her
nipple is capable of. Other moms do OK with using clean drinking water for
wetting and adhesion to the breast.


JFTR, did you know that some chain stores have Shields for sale? One of my
clients, who is just weaning her 10 week old from the sheild, was agast at
this a few days ago. She told me "They should be by prescription from an
LC, only!'

I agree.

Mary Jozwiak IBCLC, RLC, LLLL, AAPL
Private Practice

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