I've read the last few days' discussion with interest, and especially
appreciated Natalie's analysis. Last week I would have answered the
question, "no." I end up using nipple shields frequently, but have
always been reluctant to start them before the milk is in, or the mother
is at least pumping reasonable amounts of colostrum. I've based this on
having seen babies for consults after mom's milk is, trying a nipple
shield, having it look pretty good, but the scale showing poor milk
transfer. I know I can be fooled. So, I want to wait until I can
verify adequate milk transfer with the shield.
Until yesterday. I was in helping a prime after her scheduled
c-section, baby had been unable to latch, nurse hadn't been able to
help. Mom had flat nipples but flexible tissue, I helped baby latch on
multiple times for two feedings--she would get latched, draw the tissue
in well and suck for a short time, relax, lose it, and we'd do it all
over again. This is a mother who had taken no classes, was very
anxious, told the nurse prior to the birth that she was going to "try"
breastfeeding, but if it didn't work, well that was really okay. My gut
told me that if we started the normal routine of having mom pump and cup
feed, this was not going to last until the milk came in, so what the
heck. Even if baby didn't transfer any colostrum it might buy us some
time, and maybe she would be latching better by the next day. So I put
on a 20mm shield, baby stayed on, after a short time she had beautifully
flanged lips and was gulping. When she came off there was thick, sticky
colostrum all over the shield (definitely not saliva) and mom was beaming.
So, I think I'm going to have to reevaluate my position! I don't think
I'm ready to have nurses initiating them yet, but I can always
reevaluate that position, too.
Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin
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