Marla, you need to publish that study of the couplets you followed that used
shields. There is far to little research out there on the outcomes for
mothers who use nipple shields past the initiation phase.
Our nurses are like the rest, wanting access to shields and thinking that is
all they must do to count that as supporting breastfeeding. We have enough
LC's, to see every patient, and if given inappropriately, quickly move to
get rid of them. I no longer criticize the staff if given, but through
teaching, let mom know why they may not be best thing for her at the time. I
personally use them the most for flat or inverted nipples, and will also use
them if baby has a tongue tip elevation that interferes with latch. I do not
give them for soreness, tongue retraction or disorganized suck. Especailly
with a disorganized suck, I will use oral exercises and finger feeding prior
to going with a shield and get mom pumping first.
We always, have moms do insurance pumping so that we are certain to
stimulate full production, again not evidence based in literature that I can
find, but has been talked about and recommended by some LC's for years. Our
outpatient program follows these moms until babies are gaining well and
always offer a final consult to wean from the shield. And yes, I believe we
give far to many, and I've seen moms need them also as a security blanket as
well.
Interestingly enough, as we integrate new and younger nurses, they seemed to
be more uncomfortable with actually working with and teaching latch with any
considerable "hands on" approach. I actually had a newer nurse tell her even
newer orientee, "oh, I never touch a women's breast to help her breast
feed". I'm hoping that this is not the new trend, but as RN's assume more
of a teaching, less direct role in providing bedside care, this can change
how much help a mom will receive in our absence.
Just my .02
LuAnn Smith RN, BSN, IBCLC
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