Nipple shields:
I rarely use nipple shields, and often, when I choose to try it, it doesn't
actually work for that particular situation. Maybe a baby with tongue tie,
and mom with very short or flat nipples, but baby still can't latch. So I
rarely use them.
I do not make them available to nursing staff. I would suggest some sort of
education program, inservice, or even an informal one, or a memo. I would
suggest teaching early initiation of bf (first hour), skin to skin, reverse
pressure softening, hand expression of colostrum to syringe or spoon feed,
and start the mother expressing if baby can't latch. Sometimes you might
have to get to the individual nurse and give her some other things to try,
like reverse pressure or maybe she doesn't even know how to set up a pump.
Good Luck, this is an age-old LC conundrum, as you know.

Vitamins: My understanding is that vitamin D is recommended for all
breastfed babies in USA. If you search about this vitamin (not really a
vitamin) and bf, you will find the history behind this recommendation. In a
nutshell, because there were/are more cases of rickets in bf babies, and
because of not knowing exactly how much sun exposure was required, and
because of differences in skin pigmentation, and because of danger of
overexposure to the sun, it was recommended FROM A PUBLIC HEALTH POINT OF
VIEW, that ALL BABIES receive the supplemental vitamin. An individual
mother/physician could determine that the vitamin would not be given to that
particular baby. This all came about after mine had weaned, but in coastal
Louisiana we were outside alot and would not have given to my kids. The
other issue, I believe, is that vit D is not available by itself, or is
difficult to find all by itself, and is therefore in a multivitamin
preparation which a major one is made by a pharmaceutical/formula maker.
Hope this helps in the understanding of this controversial issue.

Laurie Wheeler, RN, MN, IBCLC
Mississippi, USA

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