Dear all:

My bias is in that I see all the train wrecks that come out of the hospital.  It really takes a 
determined mother to convince me to go to the hospital to see them.  

So, I don't get to see when the hospital procedures work because I don't see those women.


There are two devices that I have developed a huge antipathy towards because either mothers are 
not given enough information or perhaps they are given the information and just can't process 
that information while they are in the hospital.  These two devices are 16 mm nipple shields and 
starter SNS's.  The devices are not inherently evil and they may have their appropriate uses, but I 
find that the MISuse of these two devices accounts for a good 10% of my clients. Here is what I 
have observed.

2) 16 mm nipples shields:  The problem that I encounter with these are parents are either not told 
or don't remember being told the following:
a) How to apply the shields so that more of the areola tissue is accessible to the babies mouth
b) Whether or not their baby is fully capable of transfering milk from the shield
c) Whether or not they may need to pump afterward to stimulate the milk supply and flow through 
the shield
d) That there are larger shields that may actually transfer more milk as the baby needs to increase 
his/her intake.

  *** I have tracked milk transfer with nipple shields meticulously and I have only seen one baby 
that was capable of transferring a full feeding with a 16 mm nipple shield.  The largest difference 
was a baby that took 40 min to take 0.5 oz from a mother with a copious oversupply and then 
downed 3 oz more in 10 min with a 24 mm nipple shield.  I think it is irresponsible to hand these 
out in the hospital without scheduling follow ups at 3-4 days and again at 1 week to verify milk 
transfer.

Here's what I have seen as a result:
a) Babies that cannot open their mouths wide enough to take in the areola because they have 
become accustomed to the narrow shaft of the shield.
b) Babies that have lost weight.
d) Babies that are gaining slower than they should.
e) Babies that are feeding for much longer than an hour.
f) Mothers with low supply due to inadequate drainage of their breasts who are surprised to find 
out that their milk supply has not been stimulated because their baby is not getting enough out 
with the shield.
e) Mothers who are exhausted because they have been feeding baby for much longer than an 
hour.
f) Mothers who are even more exhausted because they have been feeding baby for much longer 
than an hour and have also been pumping after every feeding.


1) Starter SNS's:  The problem that I encounter with these are parents are either not told or don't 
remember being told the following:
a) How to clean and unclog the tubes
b) That these are temporary devices and they may need to buy more when they get clogged up
c) THe flow is very slow, so that as the baby needs more volume of milk, they may not get enough 
from the breast
d) That they must still pump because the starter SNS may not stimluate release of milk from the 
breast and certainly won't enable the baby to drain as much from the breast as s/he gets from the 
starter SNS

Here's what I have seen as a result:
a) Babies that have lost weight.
b) Babies that are gaining slower than they should.
c) Babies that are feeding for much longer than an hour.
d) Mothers with low supply due to inadequate drainage of their breasts who are surprised to find 
out that their milk supply has not been stimulated.
e) Mothers who are exhausted because they have been feeding baby for much longer than an 
hour.
f) Mothers who are even more exhausted because they have been feeding baby for much longer 
than an hour and have been pumping after every feeding.

These devices require adequate follow-up.  I always wonder about the train wrecks I don't see and 
mop up after.

Best regards, Susan E. Burger

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