Susan the problem with nipple shields IMHO are four-fold:
1. They're prescribed by someone whose skills are poor and who doesn't know
what else to do.  Policy suggestion: nipple shield usage to only be
initiated by IBCLC
2. A lot of baby/nipple mixes don't 'fit' any of the available nipple
shields, therefore the shield is more a hindrance than a help. Policy
suggestion as above.
3. Many mothers still are unable to latch the baby correctly, ie. with
bottom gum far enough down on breast to be compressing the lactiferous
sinuses.  Policy suggestion as per #1 and must have followup every feed
until mother competent with latching.
4. The shield interferes with milk transfer and also stimulation of breast
to continue milk production. Policy suggestion: monitor milk intake of baby
by monitoring output in the first instance and weight in the second.  Only
treat as low supply (with pumping, etc) if a documented low supply exists.
Therefore, mother and baby will need at least weekly followup initially and
continue followup whilever shield is being used.

That there is milk in the shield before, during or after feeding is
irrelevant - all that shows is that she may be leaking a little milk, not
that the baby is getting a good breastfeed.

Nipple shields really push a few buttons with me.  I know there are cases
where they have been very successfully used and are the ONLY way that
mother would ever have been able to breastfeed, but surely these cases are
very few and far between.
The majority of times I see them used are when the midwife assisting the
mother hasn't got a clue on how to latch the baby (or teach the mother to)
and so they grab a shield - the baby sucks something, rarely enough of the
breast, and they hand-over that the baby is now feeding well and must be
getting something because there was milk in the shield.  Then I get shot a
very defiant look!!
:-(

Basically I would like to see nipple shield policy note that they are an
intervention which could cause serious problems for both mother and baby
and therefore are only to be prescribed by qualified personnel and the
mother and baby must have continuing followup until the intervention is no
longer needed.

(OK Climbing slowly down off my soapbox)
Denise
****************************************************
Denise Fisher, BN, RM, IBCLC
BreastEd Online Lactation Studies Course
http://www.breasted.com.au
mailto:[log in to unmask]
****************************************************

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