Re shield use: I think it is important to look closely at what Regina
recently said and also the comments of Dr. Jack and the very competent hosp
LCs who sometimes do use shields (I include myself in this group )even
before hosp discharge. I would like to try to guess as to why we all
practice a bit differently and none of us is wrong.
Regina said "I *do* get them on the breast as soon as possible -while
they're still using bottles, actually." Regina, just maybe the hosp
environment and staff were pretty much bf unfriendly (not always
intentional) and with a skilled Lc the baby would have latched in hosp.
Maybe these babes got bottles in nsy or had long separation from mom. Maybe
in this case the shield was used "like candy" and not becoz of some latch
defying problem. I can say that recently I went in to check on a dyad and
the nurse helping her had them positioned so poorly that there was NO WAY
they were going to be able to latch. Yes, we are trying very hard to train
all staff and correct this. Maybe this baby would not be able to latch (the
mother had very flat nipples but nipple/areolar complex were easily
graspable) and wuold be given bottle. The downward spiral goes on from
there.
Regina continued "I often find that babies that are young enough (<1 month
old) are pretty-much willing (eager, in fact, if the truth be told) to go to
breast after lots of quality skin-to-skin time with mom  snip I combine that
with good teaching of breastfeeding cues". Yes, here again she didn't get
that in hosp I assume. SO MUCH IS MESSED UP IN THE HOSP. sigh.
Now knowing what I know of Dr. Jack as a great bf advocate, skilled
practitioner, and caring pediatrician, I feel sure that he sees these dyads
from birth and steers them along w/ close support and followup and even if
it takes a few days or weeks, his attitude is we will get them bf and I will
be here for you til we do. I can see how this would work beautifully. He
would not be ordering formula becoz of normal bilirubin, or becoz the baby
is 9 pounds or some other inappropriate reason. [Again, I say, this is the
job I want - working w/such a pediatrician.]
Now I must reiterate that many hosp cultures are bottle cultures and so is
the greater community and this includes the doctors, nurses, friends and
families tangential to the dyad. Also many moms have a goal of 4 wks or 2
mos to bf, and if they encounter any challenges they go straight to formula.
This makes the hosp LC job very difficult. Also hosp LC coverage is often
not highly valued so it is sporadic. Maybe there is no weekend coverage. Or
only 3 days per week coverage. So followup may not be ideal. Also many hosp
LCs can verify that mgmt sees their primary role as educating and latching
the babies since the regular staff are not "up to speed" and so followup
calls and outpatients take a back seat. I will say that all moms who need
any bf aids in our hosp are flagged high risk and followed as outpatients.
I feel this discussion is most productive and I appreciate all the different
viewpoints that have been offered. Still learning and ever humbled by the
great ones of lactnet.

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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