Dear all:

I also want to point out that my training had demonified nipple shields.  I was told that they would 
always limit intake and milk production.  That these were archaic devices that should never be 
used except in extremely rare circumstances and I never was taught how to use them because I 
was never shown what that circumstance was.  I was trained to use the SNS for everything.  

It is Lactnet that pushed me to do more reading and overcome my fear of the nipple shield.  I 
worked with it, figured how how it was helpful and how it was not and now feel confident in its 
use.  Again, there are general use for its use that I have sometimes violated when the specific case 
really seemed to warrant an unorthodox use.  At the same time, I started analysing when a tube at 
the breast really wasn't helping.  I rarely use either tool and I see a lot of misuse of both of these 
tools, but I don't demonize the tool. 

Now that I think about why these tools are misused - it is usually due to the fact that those who 
use them are in settings where they cannot spend a lot of time with any one mother and they have 
a limited ability to do follow up.  Thus, they do not see the consequences when these tools are not 
working.  The circumstances of their work settings are very unlikely to change, so it would make 
sense to me if some system of referral for follow up should be implemented.  

Ditto with scales.  In some settings, it may be much more appropriate to refer difficult cases where 
a scale might be appropriate to someone who can do the regular follow in a manner that won't 
stress out mom and where the scale can be used as a teaching tool to get mother to trust her own 
observations by someone who can do the longer sessions and regular follow up.

Best regards, Susan Burger

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