More on the continuing saga of the nipple shield, just my thoughts.

I agree with Deb Ferrarello that "nipple shields have been a godsend" in many
instances.   I think most LCs would agree it is never the first option we try
but in my opinion it is far better to have the baby on the breast correctly
with a shield than continue with pumping and supplementing and not getting
the baby on the breast at all.

Part of the criteria I use to decide if a nipple shield is a viable option
is:  has this baby already been exposed to artifical nipples? (and I include
finger feeding in that catagory because since when did you ever see milk
coming out of a finger.....but seriously they provide a firm feel in the
palate similar to bottles...IMO).   The other part of the criteria is can mom
or I get this baby on the breast at all without it?    Some of the problem
leading to misuse or overuse of nipple shields may occur with this second
criteria because there are a variety of skill levels in getting babies on the
breast who are having a tough time with latch.   Certainly there are those of
us who have better success with difficult latches than others.   We probably
all remember the days when shields were inappropriately offered at the first
sign of difficulty, I certainly don't want to go back to those days but I
find that other "tools" are currently being offered in the same vein rather
than providing more helpful and time consuming support.

I think that the reason some babies are getting more milk with a shield
probably has many aspects but the most significant one that I believe I have
observed is the ability of the shield to stimulate a suck.   When a baby has
been getting bottles or finger feedings they are used to that firm sensation
on the palate to stimulate a suck.   When mom gets the baby to the breast
without the shield, especially if she has flat or retracting nipples the
nipple/areola does not provide the same level of obvious sensation that the
shield does.   Some babies will do one burst of sucking without the shield
but as soon as they pause the nipple slips away from the palate and the baby
has no stimulation to suck.  With the shield in place correctly the baby
continues to feel the stimulation and when taking a normal pause resumes
sucking without additional encouragement.   Obviously a baby will get more
milk when more effective sucking is occuring

> Does getting "more" milk have anything to do with Mom "believing" that the
> nipple shield is the savior and relaxing, thus allowing optimal letdown?

The relaxing may help with the let-down but more importantly in my opinion it
allows both mother and baby to start to TRUST that feedings can occur
effectively at the breast.

> Speaking of "breast- refusing infant who has had many bottles".....isn't the
> problem two fold.....NICU's that use artificial nipples instead of the many
> other options......

I think bottles are here to stay and I'm not even sure that with the right
support bottles interfere with breastfeeding anymore than other supplemental
feeding methods.  (I know I may take some heat on this) I don't think I have
seen any articles comparing supplemental feeding methods to each other in
regards to breastfeeding outcomes when high quality support is available.
I have seen many babies who have a tough time with flat or retracting nipples
after being finger fed and feel I am equally successful getting babies to the
breast after both finger feeding and bottle feeding.  (I know.... someday I
need to do a study on this "theory") That may be because I have had to become
extremely comfortable with bottles because the population I work with usually
opts for them when supplementation is needed.

>and standard nipple confusion which can be broken quickly
> if baby is at a healthy enough weight to endure the initial first day that
> is
> toughest if going cold turkey back to breast?

I'm not sure "cold turkey" may have been meant the way I am reading it.
(cold turkey to me implies some stress or difficulty making a transition
related to an abrubt withdraw of something of comfort)  I'm not comfortable
with babies going cold turkey off supplements or on to the breast because it
creates stress for the baby and the mother in my opinion and acutally reduces
the chances of success.  Many moms are understandably disinclined to stress
their baby and will abandon breastfeeding attempts if stressing the baby is
part of the plan to get the baby breastfeeding.    One of the most important
goals I have when working with any mother baby couplet is to make sure they
are both relatively comfortable through the process.    The shield often
works as that comfortabe "bridge" to get us to the goal of effective and
exclusive breastfeeding

>Couldn't the risk of contributing to increased mastitis also be linked to
> inadequate draining of the breast, even tho Woolridge disagrees?

I think in many cases the risk of mastitis may decrease with the baby on the
breast correctly with a shield over exclusively pumping.   Frequently moms
are overwhelmed with the routine of trying to get the baby on the breast,
then supplementing because no latch occured, and pumping.  Often the pumping
is the first thing that suffers leaving the mom vulnerable to mastitis and
low supply.

Thank you for the opportunity to share what is most definitely my long winded
point of view, I welcome feedback.

Kathleen S. Kuhn RN BSN IBCLC
ParentsPlace.com LC
Private Practice LC
Eastern PA

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