Re: the recent cut-the-shield discussion:

At our lactation center we do not cut nipple shields.  I remember back a
hundred years or so when I was a LLLL that our advice included something
about cutting back the nipple shield.  However, I do not consider that
current best practice.

Our method now is to get things going with the nipple shield, i.e.,
overcome whatever problem necessitated the use of the shield, then begin
the weaning process.  1)Offer the breast with shield in place as usual.
2)When baby has begun suckling well and gulping  3)Quickly and gently move
baby off the breast and move the shield to mom's lap.  4)Quickly and gently
offer the breast without the shield. 5)Baby either attaches and nurses
properly without the shield or he does not. 6) IF he does not, replace the
shield on the breast and continue feeding with it. 7)Try the same thing
again next time. 8)Repeat until baby is not requiring the shield.

This procedure may take one try and off the shield or it may take one try
per feeding for a week or so.  I encourage moms not to worry about the
shield and not to try more than one time per feeding to feed without it.
They seem to focus on the sheild rather than enjoying the feeding otherwise
resulting in unhappy mom and baby.

I do not think that we have shield problems.  We freely use them when we
think that they are appropriate.  Our lactation staff is quite experienced
having approximately 45+ years lactation experience among the 4 IBCLCs.

None of our practice is set in stone -- it is constantly in flux as we
continue to learn more.  If anyone has a better way of weaning from the
shield, please share it.  We just have not considered weaning from the
shield a problem.

Pardee Hinson, MPH, IBCLC
Mercy Lactation Center
Charlotte, NC