Veronica,

At 07:26 AM 12/11/03 -0500, you wrote:
>I am an LC, & RNC working in a hospital with a large NICU and
>Continuing Care population (Growers and Feeders with assorted
>premi stuff).
>
>One point 5  LC is on to cover post-partum, Nicu, ccn, pediatrics, calls
>and out-patients.

Whew.  That sounds to me like one busy half of a lactation consultant.

You also said,
"Are people getting consent forms signed by the mother when shields are
used?"

Yes.
We have a nipple shield sign-out checklist that -- if I ever put the nipple
shields back where the night nurses can get at them -- I will ask the
nurses to use.  It's quite long and thorough.  No one is supposed to give a
mom a shield if she can't check off all the boxes saying she's tried this
and that and the other thing already.  Right now we are really saying no
one should get a shield w/o seeing me, as I am not as busy as your LC and
we don't have as many babies who fall into categories where shield use is
often a good strategy.
We also have a shorter consent form for the mother that includes "I have
been taught appropriate latch and positioning techniques" so that no one
should be giving her a shield w/o evaluating mom/baby and teaching them
what they need to know.  When I give a shield out to a mother I sometimes
send a copy of that form to the MD, who then learns about the potential
problems and the most cautious way to use shields.
In your situation, it sounds as if you might not need to start at the very
beginning or worry quite so much that shields will just be handed to moms
with sore nipples.  The things that spring to mind (and have probably
already sprung to your mind) are to make sure they are not giving them to
dyads who don't need them, that they check that the shield is the right
size and actually helps that mother/baby (better latch and/or higher intake
by observation/test weights), that they are teaching the moms proper
technique (both position/latch and shield use), that they encourage some
direct lapping of the nipple when the baby doesn't actually have to eat,
that they explain how to gradually wean from it, and that they teach the
mother to maintain supply.
Marie Biancuzzo's Breastfeeding the Newborn: Clinical Strategies for Nurses
has lots of information on amount of pumping for a preemie,
etc.  Incidentally, she questions whether preemies actually always do
better with the shield, or if so, whether it's for the reasons Paula Meier
gives.  I don't think she's saying it never helps achieve or maintain a
latch, but is questioning whether shields should be routinely used even for
preemies who already latch and nurse on the bare breast, on the theory that
even these babies will get more milk with the shield than without.

Elise
LLLL, IBCLC
New Hampshire



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