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Date: | Fri, 14 May 2010 11:28:39 -0400 |
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I agree with Susan Burger that we don't need to make blanket
recommendations for pumping when mom uses a nipple shield, just like we
don't want to make blanket recommendations about pretty much anything
without a good assessment, and then we individualize our recommendations
accordingly.
I too use test weights to confirm whether a baby does well with the
shield or not, and I don't let moms keep the shield if it didn't work
well. In my most impressive case, a baby with torticollis and a very
asymmetrical mandible (it was at a 45 degree angle to the maxilla on the
shorter side), the baby transferred 0 without the shield, and 3 oz (85
ml) from one breast with it! If we made that poor mom pump, she would
have developed an oversupply.
Moms using nipple shields do require careful counseling. They need to
know to watch baby's behavior and diaper output, and how to intervene
quickly if baby needs more milk to avoid their milk production dropping.
They can be taught to count stools and watch baby for excessive
sleepiness or fussiness and start pumping and giving extra milk
immediately, and come back in for a follow up as well, if they see
adverse signs.
The big problem with the 'medicalization' of lactation consulting is
that there is a push to 'protocolize' everything. Natural systems that
involve two individuals have so many variables that this is difficult to
counterproductive. While it is vital to understand the system design,
function, and interactions, it's not possible to have a one size fits
all solution for each potential problem. Just one more reason why it
takes a long time to develop true expertise in this field, and why our
mentoring programs are so valuable.
Catherine Watson Genna, BS, IBCLC NYC
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