I don't have a policy to share, just some thoughts. I think the most
important thing to include would be the need to assess for adequate intake,
need for complete breast drainage, and need for follow-up and weight
checks.

Documentation of proper teaching is essential. Pictures of how to apply the
shield correctly, and what a good vs bad latch looks like with the shield.
The shield we use (Medela) comes with a handout, and shows these pictures,
although the pictures are very small.

As to having a policy on when and why a shield would be given out,
especially by someone other than the LC, I think I am against this. Some
mothers will absolutely give up if you do not find a way to get the baby to
latch right away. Some mothers absolutely insist they need a shield and
need to be given one, even though you might assess that she doesn't need it.
I have made a supply available to the nursery, as I am the only LC and work
Monday to Friday, day shift, or less if census is low. I do not find that
they overuse these at all. I have given them some guidelines and especially
about letting me know so I can follow up. And having some other
interventions to try like Reverse Pressure Softening. So guidelines for
staff are better than policy, I think.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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