"Is it standard practice (evidence based practice?) to always have a mom start pumping while baby is using a nipple shield. Nipple shields are not encouraged of course when used we always instruct how to wean to natural nipple asap. I'm just concerned about "needing to pump, too" and continue nursing while INPATIENT.....  It seems a bit overwhelming for our new women going through her stages of recovery from birth into motherhood."

As someone who sees moms only in the "outpatient" (home, La Leche League, WIC office) situation, I can't answer your "standard practice" question - but can answer the "outcome" part of it.

The short answer is - yes, but use hand expression not pumps...while facilitating pump access once discharged if baby is still needing to use the nipple shield.  Close follow-up and evaluation of the breastfeeding _must_ be done within 48 hours (preferably 24 hours) after discharge.  If nipple shield needs to be continued, I usually recommend hand expression and/or pumping after nursing for at least the first 3 weeks - until baby has demonstrated good milk transfer skills with the shield - or has been weaned from it.

The longer answer (for the time in the hospital):

Starting with "why is the shield needed in the first place?"  If baby is ineffective, weak, unable to latch effectively, sleepy, not likely to stay or latch _very frequently_ during those first few days in the hospital - then yes, milk needs to be moved.

However, the real question is: _how_ to move that milk during the first few days postpartum if the baby does not do it well (whether using a shield or not)?  Pumping takes a lot of extra time - setting up pump, plugging in, cleaning before and after, etc. That IS overwhelming! Hand expression is key - giving mom _frequent_ (when you're awake, every 30 minutes or so for a few minutes) opportunities to practice (I compare this to learning how to knit, crochet, or decorate a cake with frosting tubes, etc.  You don't learn this by doing one stitch or one line once a day).  What better time to learn than when she is not responsible for cooking, cleaning, washing, etc.?

The moms that I see that are most successful had that rare nurse who taught hand expression and then when going into the room  asked for "return demonstration" each time. This does not take long, but increases skills and milk "removal".  It also teaches mom where her "secret spots" are that allow her to help her baby transfer milk by compressing when breastfeeding - if baby needs help!

Nipple shields, like seat belts, give the impression of safety and effectiveness, but if there isn't a good "driver" and a good "car" - baby can go downhill fast!  It's best to "protect the milk supply" during those first few days, so that those of us that see the baby after discharge have something to work with.  Otherwise we have to resort to a "crutch" (the F word) as mom builds up her milk supply.  

Yes, there is a risk she will feel overwhelmed - but I think that's a normal status for a newly delivered mom.  Our job is to provide her with options and rationale for those options as well as encouragement and reassurance that she can, and that there are people to help her, both in and outside of the hospital (I hope you are linking her to outside resources, as "Step 10" of Baby Friendly states).  As a mom once told us: "don't tell me what I can't do, tell me what needs to be done and let me decide if I can do it or not."  

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA   

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