My experience using nipple shields with preterm infants recently sent home
from the NICU closely matches Maureen Allen's.  Feeding stability is
increased by the fact that negative pressure from the first few sucks then
holds  the maternal nipple in an extended position inside the shield for the
duration of the feed.  This decreases the amount of work the baby then has
to do to keep the nipple pulled into a teat.  Also, milk tends to pool in
the teat cavity and provides a reservoir of easily accessed milk.  This
gives a quick milk reward to the baby who is weakly sucking.  Obvioursly,
baby must be correctly positioned, milk supply may need extra support at
first, and the right size shield must be employed.

What is really frustrating to me is all the ph calls I get from distressed
women who tell me hospital nurses gave them a shield, but immed. made them
sign a scary looking consent form that lists a lot of dangers.  Then the
moms are told to stop using the shield almost immed.  They can see the
shield is working (if proper size -- the newborn small size -- has been
employed).  It compleletly confuses mothers to be given a piece of equipment
and then to be told to stop using it or the baby will fail to thrive.  It
would be better to have the nurses and LCs had an understanding of how and
why shields work and not be so ambivalent about it.  If the appropriate
clinical rationale is employed to select and intervention, then there is no
reason to scare moms. Instead, provide accurate info about red flags for
poor gaining (which should be standard operating proceedure with or without
shields) and provide timely follow-up.  Babies come off shields when they
can access the breast and the miilk without the shield.  Failure to follow
up is a deficit of the health care provided to postpartum dyads, not of the
shield itself. The shield is a low cost, effective clinical intervention in
specific cases.  There is good literature about how they work.


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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