I've read the last few days' discussion with interest, and especially 
appreciated Natalie's analysis.  Last week I would have answered the 
question, "no."  I end up using nipple shields frequently, but have 
always been reluctant to start them before the milk is in, or the mother 
is at least pumping reasonable amounts of colostrum.  I've based this on 
having seen babies for consults after mom's milk is, trying a nipple 
shield, having it look pretty good, but the scale showing poor milk 
transfer.  I know I can be fooled.  So, I want to wait until I can 
verify adequate milk transfer with the shield.

Until yesterday.  I was in helping a prime after her scheduled 
c-section, baby had been unable to latch, nurse hadn't been able to 
help.  Mom had flat nipples but flexible tissue, I helped baby latch on 
multiple times for two feedings--she would get latched, draw the tissue 
in well and suck for a short time, relax, lose it, and we'd do it all 
over again.  This is a mother who had taken no classes, was very 
anxious, told the nurse prior to the birth that she was going to "try" 
breastfeeding, but if it didn't work, well that was really okay.  My gut 
told me that if we started the normal routine of having mom pump and cup 
feed, this was not going to last until the milk came in, so what the 
heck.  Even if baby didn't transfer any colostrum it might buy us some 
time, and maybe she would be latching better by the next day.  So I put 
on a 20mm shield, baby stayed on, after a short time she had beautifully 
flanged lips and was gulping.  When she came off there was thick, sticky 
colostrum all over the shield (definitely not saliva) and mom was beaming.

So, I think I'm going to have to reevaluate my position!  I don't think 
I'm ready to have nurses initiating them yet, but I can always 
reevaluate that position, too.

Becky Krumwiede, RN, IBCLC
Appleton, Wisconsin

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