Maureen wrote:

"We use the Medela small  shields--we've tried Avent and Hollister
too, to be fair, but they are far too large to fit a premie's mouth
without
making them gag. "

But what about the size of mom's nipple?  I find that most nipples
are larger diameter than the samller shield. (Not just a little, but
significantly larger around.)   In my experience they tend to pinch
on mom's nipple since it can't fit into the shield.  And yet, this
seems to be the one that works with premies.  What am I missing
here?

"We teach the mothers to try without the shield
when the baby can pull the nipple about three quarters up the
shield,"

Then where is the baby compressing?  Whenever we use a shield, we
have mom turn it partially inside out, place it over her nipple, and
then by gently pulling or tweaking the nipple part of the shield,
her nipple is already at least partway into the shield.  This way,
baby's jaws are compressing past the base of the nipple instead of
on the nipple itself.

I understand what Paula M. is saying in the research about helping
the baby with less oral musculature development to maintain the
nipple/areola in the mouth so it can concentrate effort on removing
the milk instead of just keeping everything in place.  However,
these questions have bothered me.  I shall go back and read the
article again, but I would be interested in comments from others who
have used this approach successfully.

Winnie Mading RNC, IBCLC - wondering if Spring will ever really
arrive.  We haven't had a 50 degree day since last November!

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html