In a message dated 5.9.02 9:05:57 PM, Veronica writes:

>In our practice, we work with lots of premi's, and shields are a wonderful
>effective tool.
>When we have to send a mom home using a breast shield, currently in our
>practice, we are trying to do follow up phone calls to the moms.   Among
>the
>LC group with whom I work, there are strong differences of opinion whether
>we should call moms, (to support her in use or weaning, not to mention
>cover
>our liability). The other half  of the group feels that she is a MOTHER,
>grown up, and we should instruct them to call us if they have the need,
>and
>leave it at that.

As an adjunct to the many archived posts written on this, I have strong
feelings about the need for shield f/u.  Although I believe that nipple
shields are a valuable tool, I also see many probs with their use (see my
post 5/7).
While using a shield, I have found that many babies either don't latch deeply
enough or they drift back on the nipple. If watching this, it appears that
the baby is making a *trough* at the base of the nipple. After seeing this
many,many times it seems to me that the shield itself, encourages this
because of the way that the flanged part anchors or most often *doesn't*
anchor around the areola and because there is essentially a joint there
(where the nipple base meets at a 45 degree angle to the flanged part). This
encourages the baby's lips to *plant* at that joint (!) rather than further
back on the flanged area. If the baby is assisted in the hospital with shield
use (compression far back on the breast helps), the skilled practitioner can
help to maintain the deeper latch and effectively *train* the baby in its
use.  If not, the often overabundant early supply can mask the aforementioned
potential problems . Once home the *potential* supply problem is often
realized as the supply drops off in response to the lack of milk tx d/t the
shallow latch.
Ideally these babies that *tend* to latch more shallowly in the hospital
would be flagged for closer f/u BUT telephone f/u has its limits since many
of these babies would have reported adequate output, frequent fds that
*appear* to be nutritive. I say *appear* because Very often these shield
users are slurpy, noisy fdrs and this can easily be mistaken for good milk
tx. Also, many hospital practitioners have relatively limited experience with
shield use, particularly the issues encountered once home (we really haven't
been using them very long!).
Most likely, these issues are less of a concern with the very practiced
shield user ie. the premie that has been using one for *weeks* while
hospitalized BUT at the least (!), the HCP should be alerted and prepared to
follow babie's weights more closely than the typical 1-2 wk post d/c check
AND Moms should be encouraged to initiate or maintain adequate, skilled
support once home.

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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