I worked in a hospital where nipple shields are available to the staff and I
do have my issues with this easy access.
I want to first go on the record that I do believe that nipple shields are a
great tool and definitely have a place in lactation support.
Shields do have a place in the first 3 days but I would say not the first 24
hours.  Even moms with flat or inverted nipples, some babies given the chance
can latch on and then go on to nurse beautifully, hence the theory of
"imprinting".
I agree that even when a shield is placed on correctly in the first 24 hours
a baby will have more difficulties obtaining the tiny amount of colostrum.  I
like the ideas coming across the pages of LACTNET recently on how to best
retrieve the colostrum in the first day and this would be more beneficial for
these babies, who are not that interested in nursing, than sucking on a
shield.
I do think that a shield can come into play on the second day, based on a
case by case instance.
An example was this week I worked with a primip whose baby was very mucousy
on the first day while I was there.  Her nipples were a little flat but the
areola was very soft and flexible.  I had encouraged skin-to-skin and
watching for cues.  I had showed her how to express her colostrum but then I
went home.  When I came back the next day the mother had the baby fed in
twice during the night with a bottle (that is a whole other issue!).  The
baby was more alert the next day but with a combination of flat nipples, used
to a bottle and the baby grabbing its tongue when it opened to latch, the
nursing was going no where fast.  I opted to use a shield to assist in these
3 problems.  It did help and I think this baby can be weaned fairly quickly.
What irritates me with shields and their use in the first 24 hours is when
the staff want a baby to nurse and they are impatient that some babies are
not interested in breastfeeding at least not on other people's schedules.
I have to get on my soap box and say that I am not pleased to see shields on
the shelves at the local stores.  They should be recommended and followed by
someone who knows what they are doing (preferably an LC).
Our work is just increasing.
Ann Perry RN IBCLC
Boston, MA

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