Dear Lactnet Friends:

Every clinician has an opinion,  backed by experience, about nipple
shields. We've heard some excellent ones here in this discussion.

What is really needed is a good research study about term infants and
nipple shield use that includes follow-up at home.  Like any tool, they are
useful in specific situations. We know about preterm infants and nipple
shields.

Powers and Tapia published the concept of using pre/post feed weights with
the shield to monitor milk transfer in order to know if the mother needs to
pump when she is using a shield.  Now that's an interesting idea that needs
fleshing out, because we know that babies don't always take in the same
amount every breastfeed.

My concern is the first 2 weeks or so after the placenta is delivered from
a mother at term, the time when the prolactin receptors are being primed.
Having had a client who was given a shield in the hospital (she did not
know the reason), who went home using the shield and always saw milk in the
shield when her baby was done with a feed, and whose baby was readmitted in
week 2 for failure to thrive, I am reluctant to avoid pumping, at least in
the first 2 weeks. (The mother in question was breastfeeding often enough,
responding to her baby's cues.) There have been similar cases.

Which mother is at risk of diminished milk supply if a shield is used? How
do we find out? We don't know.

What is the best way to wean from a shield? Cathy Watson Genna said at a
conference, "when the baby gets excited at the sight of the bare breast."
Any other ideas or techniques that are proven to be useful? We don't look
good professionally when a mother goes home using a piece of durable
medical equipment and we lack a proven method to stop its use. I wouldn't
want my orthopedist to send me home with crutches and let me figure out
when to stop using them.

Oh please, somebody do a good research study, with follow-up. Otherwise
this debate will not resolve.

warmly,

-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Author:* Complementary and Alternative Medicine in Breastfeeding Therapy*
www.breastfeedingalwaysbest.com
https://www.facebook.com/nikkileehealth

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