Blanket statements and cookbook recipes just don't work IMHO. Nipple shields can reduce transfer or increase transfer. Jean Cotterman's info about the breast ejecting milk after let-down occurs is exactly on target. But the amount ejected depends on total volume and capacity of the breast. That is individual. That's why, to me, nipple shields can have various issues, depending on the person and the cause for using. A baby who has a tongue tie and cannot cup around the nipple and blocks milk ejection may benefit from a shield if the t-t can't be clipped or the issues isn't immediately solved. A mother who has very damage nipples may be able to continue to feed with the shield on - it depends on WHY the damage. I think in tight inflexible breasts, reverse pressure softening and extended massage should be used first, then the shield, then take it off. Isn't the critical thinking skills needed for a good lc what we are talking about here? If we can just write a set of instructions and put them on a box and sell a product, there's no need for doctors, or lactation consultants, or dieticians, or exercise coaches or any other personal coaching or helping. Just go to the internet and your local target. But we know that doesn't work. We need mentors and experience and research and individual touch!
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Susan Burger
Sent: Thursday, May 13, 2010 8:44 AM
Subject: Re: Intake with nipple shields
Dear all:
I am a bit confused about some of the blanket statements that babies take less with the nipple shield. Am I in a minority in terms of actually measuring whether or not the nipple shield helps the baby take more? I would say that the primary reason why I suggest a nipple shield is when a baby is incapable of initiating or finishing feedings on the breast. I rarely use nipple shields unless milk transfer is improved. I have lots of clinical data on full term infants who are able to transfer more milk with the nipple shield -- but I am selecting infants based on their inability to transfer milk. So this may explain differences in observations if others are predominantly using nipple shields for other purposes. I do not find that they work well for reducing pain -- usually improving how the mother and baby attach works better. So I rarely use them for that purpose.
Furthermore, although I do tend to ensure that supply is copious while a mother is using a nipple shield, I have met plenty of mothers of full term babies who are able to maintain their milk supply adequately while using nipple shields for prolonged periods of time -- PROVIDED they have a copious supply at the start and the baby is transferring milk well EVEN IF THEY ARE NOT PUMPING AFTER EVERY FEED. If a baby is capable of removing more milk with a nipple shield and is removing an adequate amount to satisfy their needs, why would you suggest that mothers pump after every feed? If I am unsure and it is early in the process I may suggest pumping once or twice a day based on the individual case, but I certainly don't make blanket recommendations for all women using nipple shields. Pumping 8 times a day is challenging. If a baby is feeding adequately and the supply is copious, why would you add 80-120 extra minutes or more to her daily routine? Is there any evidence that this is necessary for full term babies who are transferring an adequate amount of milk?
Of all the situations in which a scale is useful, I would say that testing milk transfer with and without a nipple shield is important. I find it harder to separate the fakers from the feeders when using a nipple shield.
Best, Susan E. Burger, MHS, PhD, IBCLC
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