I keep in touch with mothers who have left the hospital using nipple  
shields.  I've only had a few mothers who did not bring in a full supply  while using 
a nipple shield. And that is without using a pump. 
 
One right now I'm watching and will see tomorrow one mother and baby  because 
the baby had lost 10% at the first check-up after leaving (usually  4 to 5 
days old.) I wondered if the baby had Down Syndrome when I saw it on  day 1.  
After discharge a conversation I had with the staff nurse revealed  she wondered 
the same thing. I assumed the baby's doc would pick up on it if it  was. 
Mother does have a pump and is pumping to establish good supply. 
 
The work of Paula Meier has shown that premature infants often do better on  
the breast with a shield which allows them to conserve energy.  That said,  
mother vary widely on the consistency and volume of colostrum.  Once after  we 
expressed one large drop of colostrum  (and no more)  the mother  was bringing 
the baby in to transfer it to the baby's lips or tongue,  it  stuck to the lip 
and had already jelled into a solid drop!  I was  astonished. Another mother 
was able to pump an ounce and a half from each breast  on Day 1.  It's rare to 
see that much for many mothers on Day 2. Often  pumping rather than hand 
expression results in drops of colostrum all over the  inner surface of the shield 
flange and tunnel and if any makes it the sides of  the bottle.  These drops 
don't often coalesce and are hard to  collect.  We do try to with a dropper. 
If we do encourage a mother to pump  it is for the stimulation to increase 
hormone levels when a baby is not opening  his mouth and there has been no latch. 
 
Once mother who not only had a c-section birth, but had to go back to the  OR 
to remove a clot was not able to get her baby latched.  I did help the  baby 
get on to a very large soft breast without a shield, but this baby  kept 
losing his grasp.  This was with a good off-center latch with that  baby's mouth 
wide, and the breast supported so the weight of it wasn't pulling  it from the 
baby's mouth. We tried hand expressing colostrum but got only the  tiniest 
glistening drop. Introducing the shield (at 14 hrs of age)  really  helped him 
settle and suckle for a good twenty minutes. I heard some  swallowing only after 
five minutes at the breast. I believe that the  stretch of the nipple is an 
important source afferent nerve impulses from the  breast to the brain and can 
effectively raise prolactin and oxytocin levels. The  baby was then able with a 
lot of work during the night (good nurse on duty) to  achieve latch without 
the shield. I usually never use a shield on the first day  of life.  This was 
an exception.  
 
Another one is if the baby has a very hard tongue thrust which continues  not 
matter how well the baby is positioned and latched. And the mother already  
has a cracked or blistered nipple. (I've noticed that if you watch  babies on 
the first or second day of life and see them playing with their  tongues, 
poking them out, holding the tip of the tongue between their lips and  sucking, all 
habits acquired before birth, that these are the babies who  suddenly lurch 
off of the breast, or back off to latch more shallowly during a  feeding. Some 
of these sustain a decent rhythmic suck and when relatched good  tongue 
movement for a time; others cause friction and nipple abrasion.) We  use a shield to 
protect the mother and allow the baby to nurse in her  arms. Often when 
copious milk appears, the baby is able to start to sustain a  better tongue 
movement during the steady suck-swallow - breath bursts of suck  and the shield use 
is discontinued, but not always.
 
 
Mardrey Swenson, IBCLC
 

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