Hi, y'all,
        Very timidly I wish to say that since reading here on our
wonderful Lactnet forum the tips from the ILCA Cnf in Kansas City that I
have had to eat my words and try a nipple shield.  I'm the one who used
the nipple of the old rubber ones as a nose to draw a frowny face to show
at inservices and bf classes.....yeek!.
        Dr. Jack, I hope you know how much courage it's taking to write
something that seems to contradict you.  Gulp.  I think we ought to play
the darned things like a kazoo and let a panel of judges decide...at 10
paces.   Barbara, maybe we can share a caldron of hot water?
        First time, the mom had been sent home from a rural hospital with
a *rubber*--the hard kind!--nipple shield and she got teary eyed when she
tried a silicone one a generous pump rep had given me "in case it would
ever come in handy"  this mom was so amazed at the difference, and
stretching the darned thing to slurp in her nipple (professional terms,
huh?) made it stay on all by itself.  The mom was so danged pleased with
the thing it was *weeks* before she wanted to try going without--whipped
it off in the middle of the active swallowing following a MER and baby
latched back on and that was that for the ole nipple shield.  I truly
believe this dyad would not be bf today without using one.
        Other case(so far) was a 15 year old mom whom I saw in the
hospital on the day of the birth..she'd had every intervention known, and
a few they invented just for her, and her nipples, huge anyway, and
areola were so swollen (yes, stadol was used) the baby's mouth didn't
have a hope.  This mom was shaky, whiny and *in pain* from a section and
still on IV for antibiotics-"why?  Because."--, so I didn't see the edema
resolving anytime soon.   After a 90 min visit (unpaid--she's medicaid) I
pulled out a normal sized nipple shield (wasn't sure it'd fit, but that
inside-out-rim-and-stretch-technique surprised even me) and voila.  Used
it for 5 days. Again, I doubt that this mom would have endured--NOT at
all interested in pumping to maintain supply.  Just a
make-it-work-*now*-or-we-can-use-the-bottle attitude.
        Now, I haven't changed my attitude about nipple shields in
general--they're a dangerous quick-fix in the hands of a non-expert.  As
a last resort with someone who is willing to do intensive follow-up, they
could save a breastfeeding relationship. And yes, I have a consent form
for their use I have the mother sign.
        And I'm humbly learning never to say never....
        Karen Zeretzke, MEd, IBCLC
        Baton Rouge, Louisiana