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Date: | Wed, 12 May 2010 00:48:19 -0400 |
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Many thanks for all of you who took the time to e-mail be at my regular address for suggestions on wording a donor milk Rx. I love Lactnet!!
My ten cents on nipple shields. I tend to size them to the baby's anatomy. The best research we have for use is with preemie populations- and those babies need the breast to be sized for them or we have a whole lotta oroboobular disproportion. Of course there is a balance, but that is where I start. I also canot start a mom with a nipple shield and not worry about milk supply. It is a barrier- some kinds are transferring more milk, but some are transferring less. How do i know who is who?? I don't unless i also have every mom with a nipple shield do test weights. Plus it works best for populations that are moving the least amount of milk- oral anatomy problems, preemies, small near terms. These are the kids who are already having trouble moving milk. These moms should be insurance pumping at least a couple of times a day.
I am very concerned with nipple shield use in my area of the world (San Francisco). Both of our big birthing hospitals are sending a huge percentage of mothers at our practice home with one. The diagnosis? Flat nipples. Really?? every mom in our practice has flat nipples?
I have used them for a number of situations (usually preemies, small near termers, and oral anatomy issues). I have used them for flow problems with babies with boarderline tongue tie- (they nurse ok, but cannot handle niagra falls). I cannot remember a time when I have not had some position (I can get very creative) or breast compression (tea cup hold, nipple sandwich etc) work for a "flat nipple" provided the breast tissue is adequately malleable. If the nipple is super flat- but the breast is squishy, a tea cup hold usually helps. If the breast is hard- well then we need to be moving some milk- hand expression, RPS, massage, however you get the milk moving and the nipple soft- we should be doing it.
I worked postpartum as a nurse. I know the grind. I know Nurses are rounding on 5-6 mother baby couples in the first two hours of a shift. I know a lot of the kids are drugged to the eyeballs, and most moms have pitting edema (or they did where I worked in VA). But I cannot get past the "follow question"- if I plunk a nipple shield on this mom _who is following up_? Who is checking the latch?? Who is re-evaluating when the milk comes in?? Who is checking up on milk supply?? who is weaning this kid off of the shield after three weeks of a hyperstimulus?? For most moms the answer is no one. And that is not a great situation to stick a piece of silicone.
Frustrated in the Bay Area.
Charity
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