Barbara:  Because your post mentioned two subjects (nipple shield over use
and herbs) I have discussed recently, I'm assuming (perhaps falsely) that
one of your intended targets, is me.  If it is, I'd really appreciate it if
you would email me personally as well as to the list.  I whole heartedly
agree that both shields and herbs have appropriate and inappropriate
circumstances in which they are used.  Now, let me give you a bit more
context...

I am now seeing (and these are just the ones I'm seeing) 3-5 moms PER WEEK
or 12-20+ per month being given nipple shields (both high contact and old
style) by  our local hospital nurses (none of whom are IBCLCs) and home
health (some of whom are IBCLCs).  This is in a hospital that has about 100
births per month.  COME ON...really, do YOU honestly think that this is an
appropriate level of shield dispensing?  Most of these moms have been handed
a (as in ONE) shield within 5-10 min of attempting latch and sent home with
NO FOLLOW-UP care except being told that they should get the baby off the
shield in a week.  In 90% of the cases, time at the mother's bedside would
have been enough to overcome latch problems.  Most of these moms are told
that they have flat or inverted nipples while there is very little evidence
showing this.  Most of the moms were not given any other alternatives such
as using an Evert-It (which I really like), pumps or Hobbit or othe inverted
nipple shells.  Most of these moms are terrified they'll lose or destroy the
one shield they have and won't leave home.  And, many of them were never
counseled to the hazards of shields on milk supply or improper washing
leading to yeast or bacterial mastitis.  Sorry, but I'd say that it reality
out of 100 births, if given enough support, only 2-3 AT MOST should require
this device.  I'd be curious as to what you would consider to be an
appropriate number.

Now, on to the next issue...herbs.  Yes, herbs are substances which if used
improperly without education and experienced counsel, can be hazardous.  Did
you know that 80-90% of health care even in developed nations is delivered
by lay people such as mothers?  This is a documented fact and most people
want information so that they can go forward with their self-sufficient
health management.  I must say that  I see more problems as the result of
so-called experts handing out prescriptions and people not realizing that
"even" (and I really mean especially) FDA-approved prescribed substances
given by licensed practioners need full informed consent and not see them as
a blanket endorsement of safety.  In clinical studies on health education
and informed consent, most physicians believe that they give 10 times the
amount of education than they actually do (once they are taped and count the
minutes, they actually concede to this).  If you are suggesting that I
personally am not qualified, I can provide a long list of certifications,
graduate and post-grad training, as well as professional, peer-reviewed
publications (as opposed to say my recent article in Mothering--if that is
what is really bothering you).  As a practitioner, I do not dole out devices
or herbs on a very regular basis.  However, they are options that may be
helpful if used appropriately.

My biggest concern with herbs is the fact that there is such a wide variety
in the quality, potency, and residual pesticide, toxic trace minerals, &
fungicide, of available products.  Secondly, there is good cause for concern
over interactions between ALL drugs including herbs.  My experience with
other practitioners who suggest or "prescribe" herbs is that they are more
careful with these and provide more education than prescribed medications,
which are either presumed safe or totally avoided during bf.  It is true
that we desparately need more randomized, controlled trials (RCTs) with
herbs and of course more RCTs that will address the needs of nursing moms.
I am personally conducting 3 research projects now and I serve as a reviewer
for the Office of Alternative Medicine, the CDC, and other branches of DHHS.
I mention this because some of you may not be aware that work IS actually
being conducted in this area and that most of this work takes into account
the long history of use of many alternative and complementary health
practices.   The historic context of herbs and
pregnancy/childbirth/breastfeeding is a fascinating one, which I encourage
you to investigate.

Lastly, I think that some practitioners have way too much ego invested in
the issue of patients taking action on their own behalf.  We can educate,
provide support, caution, and provide both clinical studies and lead by
example, but in the end for competant decision makers, the choice is theirs.
Do you want your patients to feel comfortable discussing all their options
with you?    Please try to have an open mind...

Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]
mom, wife, educator, lactation consultant, researcher, author, organic
gardener, photographer, lapidary creator, lousy cleaner.

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