Jan asked:

> When you determine
> that a mom/baby couplet needs to use a nipple shield, do you have her do any
> insurance pumping?  If so, when, how often, and for how long?  And why?
>
I've had mothers use quite a number of nipple shields over the past several
years.  Especially since Paula Meier's research showed that preemies tired less
and sustained being at the breast longer with their use.

We have babies from 36 weeks gestational age and up.

Uses:

1. Mothers who have traumatized nipples due to babies' disorganized or
dysfunctional sucks

2. Mothers who are at risk for quitting breastfeeding when they've been using
an incorrect position/latch and have damage to their nipples. When we get the
latch corrected many can nurse, but some still find the pain too intense and
dread feeding their babies.

3.  Babies, who no matter how much we work on latch (using concepts from Best
Feeding and articles on the off-center latch), cannot manage to get latched
on, e.g. onto a breast with flat or inverted nipples

Sometimes the shield is used only on one side. Often for one to three days;
other times for up to five weeks.  Usually for a week or so.  I've only had one
baby who never got off the shield and who at 11 months of age would bring the
shield to his Mom when he wanted to nurse!

We do not have the mothers pump.  Only twice in several years have I had a
mother who has needed to pump when their babies seemed to not be gaining that
half ounce to ounce per day. Some come back for weight checks with me when
weight gain has been a concern. Otherwise we go by diaper output and nursing
frequency and well baby visits to the doc (2 days post discharge and two weeks).  I
follow-up all mothers who are using nipple shields.

Mardrey Swenson  IBCLC

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