Mary asks: Do you think a Nipple Shield should be used at all in the first
2-3 days of life?
Well, I would like to rephrase this question to not, IF we should use
shields in the first few days of life, but WHEN will a shield be a helpful tool for
a mother and baby in the first few days of breastfeeding?
I think that the mother-baby connection, milk supply stimulation, and
feeding baby effectively without use of formula is too important to not use a
shield when it will help to accomplish this. For these reasons, I will frequently
try a nipple shield in the first few days after birth --- even at the first
feeding --- if I think it will enable a baby to maintain latch and sustain a
more effective suck than without it. After 14+ years of working with
breastfeeding difficulties, it is rare that I cannot get a rooting baby latched.
However, they don't always suck well enough to be effectively feeding. Or, a
mother may need more practice to be able to do what needs to be done by
herself to help her baby suck better. In these cases, I have seen improved sucking
bursts and milk transfer when using the shield. I think it works sometimes
like training wheels on a bike, letting mom and baby practice in as close to
normal breastfeeding as possible until they get better at it and no longer
need it.
When I have days at the hospital where it seems too many moms are starting
out on shields, I remind myself that I am not seeing normal newborn babies and
mothers. I am seeing babies and moms affected by drugs, separation, their
culture, and stress from the way we do birth here in the USA. These full-term
babies, many times, are sucking just like premature babies. Their suck is
weak and disorganized and the sucking bursts are too brief to get enough milk.
As the research shows with premature babies, I believe these babies also
transfer milk better when the shield assists their ability to sustain suck.
And, like premature babies, when the baby's energy, suck strength and
coordination is improved enough, it isn't hard to wean off the shield. Many times we
can abandon the shield before discharge at 48-72 hours because mom and baby
have practiced and have recovered enough. If not, we go over how to know
baby is getting enough and to call for an appointment if the shield is still
needed after a week. (Though uncommon, I have worked with a few cases that took
over a month until baby could do every feeding without the shield.
Follow-up with test-weighs to compare intake with and without the shield help me in
deciding how fast and hard to get rid of the shield.)
I think we have to be careful in our position as LCs not to make absolute
rules like never using a shield in the first few days. Our job is to evaluate
each mother-baby couplet and figure out with them what is going to be the
best way to manage their breastfeeding challenges. We limit our resources and
ability to adapt when we believe one way will always work and another way will
always fail. I also believe hospital LCs limit help for their mothers when
they limit the nursing staff's access to tools like the nipple shield.
(Unless, of course, we have a skilled IBCLC there 24 hours every day of the year
available for every feeding time having trouble.) Yes, the staff may use
tools too much or too little as they learn. But, isn't that how most of us have
learned what helps and what doesn't help in a given situation --- along
with good in-services? If a baby (or mom) doesn't need a shield, and we know
how to teach our breastfeeding techniques, then getting rid of the shield at
another feeding isn't hard. Even the experienced staff nurses can manage this
when the baby is ready! If baby can't do well without the shield, then we
need to look for the reason the shield is helping and provide a plan and
follow-up accordingly.
I have seen the literature change over the years. The concerns about milk
supply and inability to eventually wean off the shield are based on very
little if any research, pumping with a shield, and use of the older shields. We
now have research on premature babies and case studies on the helpful use of
the newer nipple shields (Start with lactnet archives, JHL archives
(especially the nipple shield issue in the mid-90s), and the NEWEST editions of
Riordan's Breastfeeding and Human Lactation, Wilson-Clay & Hoover's Breastfeeding
Atlas, and LLLI's Breastfeeding Answer Book, and then look at their references
for more primary ones). We now have different size shields available and
the ability to do test-weights to document feeding amounts with breastfeeding
(usually for after the mature milk is coming in) along with recognizing other
signs of adequate intake from the beginning. I expect the trend of
acceptance will continue as we learn more about how shields work, actually do
research on its use in the first few days of life, and increase our skill in
recognizing and solving problems with breastfeeding over time. Or, if I really
dream big, we will have a world where most births are uncomplicated and
unmedicated and babies can suck!
Natalie Shenk, BS, IBCLC
Findlay Ohio USA
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|