----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, May 11, 2010 5:07 PM
Subject: Re: [LACTNET] nipple shields, size
**Hello Jane and others,
You wrote:
"We have all sizes available. What we find is large shields can cause some
babies to pull back the tongue and bite. After all, anatomically, the
nipple is supposed to be drawn back onto the baby's tongue and the tongue to
cup around the nipple without "humping". WE try to fit the shield to the
baby's mouth and avoid compressing mom's nipple. If mom complains of pain
with the use of the shield, we adjust. I think an important concept is that
milk is removed from the breast by mother ejecting milk. The shield just
helps keep the "hoses unkinked"."
**I have been wondering about this concept again last weekend during GOLD.
One of the presentations was about the importance of vacuum. It made me feel
uncomfortable, because (as others have said): it is not really surprising
that someone working with sponsorship from a pump company would draw the
conclusion that vacuum is important...
Then again: people and cultures have milked cows and goats and other animals
for millennia. It most certainly wasn't enough to make these mammals feel
good, in order for them to have an oxytocin surge and let their milk flow,
into the bucket held beneath them by the human mammal hoping to catch and
use it as part of the daily menu.
The humans really had to actively *milk* these mother-animals, meaning they
had to apply *positive external pressure*. Using the internal negative
pressure caused by the MER definitely wasn't enough, just as it isn't enough
for moms who want to hand express. They have to use an effective
external/positive pressure technique to get the milk out. I had the honour
of 'practising' a few moments on a still lactating colleague a couple of
weeks ago at an intervision day we had organised as lc's from the Dutch bf
counsellor organisation. I rarely have the opportunity to do this, because
my pratice is still young and at the moment I don't have many consultations
(and those I have are not always suitable for trying). Considering the
external pressure needed, I just cannot believe that milk is removed from
the breast by the MER. If that were true, bad technique on the baby's behalf
or tt or whatever other sucking problem, would not be such an important
issue. MER helps, negative intraoral pressure helps, baby's external
pressure helps... they are all part of the complete picture, in my opinion.
That is what makes mom and babe a dyad: interdependency! I would love to
hear others' opinions on this! :-)
Warmly,
Marianne Vanderveen IBCLC, Netherlands
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