I've been following this thread closely and have been deep in thought about
it ever since I read it in The Atlas.
My bias:  nipple shields are for very few and far betweeen cases - their
use has been much abused.

A prem baby who is finally going to the breast for nutritive purposes is a
very lucky little person: his mother has already developed an excellent
milk supply, which usually flows without too much provacation and she is
well over the full-breast-difficult-to-get-a-latch stage. ie She has lovely
soft breasts full of milk and even nipples which have been 'sucked' out
repeatedly by a pump.
Hopefully he has also been doing lots of non-nutritive work at her breasts
before now too.
And, the baby is well over all the intrapartum drugs by now too - and very
keen to suck.
There will never be an easier breast to teach a baby to latch for the first
time.
My experience with premies is that they do latch beautifully - often their
gape is twice as good as a full-term just learning, and it is so much
easier to just get that breast in properly than to try to get just as much
breast PLUS a nipple shield.

I think the trick is to choose the time of the feeding when baby is alert
and don't waste time (and baby's limited energy) with obs and nappy changes
when he could be feeding. In this respect it can be difficult when the Dr
has ordered breastfeeds at certain times. The other essential ingredient is
a skillful practitioner to initially help and teach the mother good latch
techniques.

OK now Paula has done the research that shows this is not as effective as
feeding on a shield.  I can think of lots of confounding variables here,
but basically I don't think our practice should change until this research
has been corrobarated.

Going out on a limb
Denise
****************************************************
Denise Fisher, BN, RM, IBCLC
BreastEd Online Lactation Studies Course
http://www.breasted.com.au
mailto:[log in to unmask]
****************************************************

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