Nikki if you can imagine the circumstance you described, where the mother was given a shield, and the baby could latch, yet she experienced discomfort and discontinued....without the discomfort piece.
It *is* feasible for some circumstances that the mother uses the shield, the shield shapes her nipple into something the baby can manage in their mouth....*and* there is not the associated discomfort.
It's not always the solution, I've seen the approach with a shield be highly effective, and yes, I've also worked with mothers who had the experience you described....discomfort and nipple irritation to the point that it makes this intervention inappropriate for her case. 
Offering all the options, we can try a shield and see if it works....or we can use alternative methods while we sustain your supply until the oral cavity can accommodate the nipple appropriately....many mothers
will consider trying the shield. Of course they should be counseled about the potential for discomfort due to friction of the shield and so forth and in cases where that is a factor, move on to another alternative. It doesn't irritate the nipple in 'every' case...in my experience more often than not it does 'not' irritate her nipple. 
She needs to know what to look for in terms of ongoing comfort, and tissue integrity to be aware that her nipple tissue is healthy, has good circulation, and is comfortable and so forth.
I have seen this approach effectively work so I'm very reluctant to counsel mothers who are experiencing this obstacle that she has no alternative other than to wait until her baby's oral cavity is more 
accommodating. I'm also aware of the potential drawbacks and I share them with mothers so they know how to be reassured that indeed this intervention has benefits at the time that outweigh its 
drawbacks, and when it may actually be interfering, if they decide to try it. 
I recommend approaches that involve incorporating informed consent from consumers, some mothers wont care to consider use of a shield, and then we collaborate on other methods. There is a false
assumption here that this approach will be likely, or often result in tissue irritation or damage which is evidently not always the case as we can hear other clinicians describing success with this approach as well. It can work in some cases. 


Michelle H. Kinne BA IBCLC RLC ICCE CD(DONA)
www.CascadePerinatalServices.com


-----------------
Date: Fri, 29 Jun 2012 07:10:01 -0400
From: Nikki Lee <[log in to unmask]>
Subject: large nipples and nipple shields

Dear Lactnet Friends:

Would someone please explain how making a large nipple larger, (by putting
a shield over it) will help a baby to grasp the breast better?

It makes no sense to me.

warmly,

-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com




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