I provided a consult to a Mom/baby at just over 2wks pp that illustrates the
damage that this blanket dictum can do. Baby had been delivered c/s with
rocky start in hospital; level 2 stay for antibiotics and low blood sugar
(treated with sugar water!) and no early attempt at breast, later attempts
revealed diffic w/ latch, nipple shield use commenced, Mom and baby d/c'd to
home with nipple shield. Pedi apt. 2days after D/C  revealed no wt. gain,
advice to continue w/ shield, pedi apt. at 15 days revealed further wt. loss.
On consult Mom advised that she was told in breastfdng class to offer only 1
breast per feed and that she read it in several books. She was very "tied" to
this behavior and needed much support to believe that this action in itself
might explain the wt. issues.
With assist at breast baby latched w/o shield , with good milk tx despite
some dysfunctional sucking and diffic. maintaining latch. My impression was
that if Mom could facilitate an optimal latch w/o assist and offer BOTH
breasts per fd., wt. gain should proceed. She seemed to have *enough* milk
although supply had dropped off (not surprisingly!). By next day Mom's
nipples extremely sore, obtained pump. Over next few days Mom pumped and
bottle fed with some formula supps and occassional att at breast
(Mom VERY frustrated with inconsistent advice, physical pain etc) , back to
breast with little pain at each fd. but supply appears low when pumped and
pedi not happy with 1oz/day wt. gain since baby still below bw and wants to
increase supplmt....a vicious cycle.....i think you get the pix!
On last conversation Mom still struggling and too angry with the
*establishment* to really bond with me and trust my advice.
I did speak with the LC at the hospital of delivery. Her response was that
the Mom was dc'd with clear, documented, appropriate advice regarding use of
the shield (although no mention was made of use of both sides) AND that she
was telephoned once home and according to documented info. (Mom's
recollection of pees and poops-don't get me started on them!) the baby seemed
to be feeding well.
Obviously this scenario involved much more than the "one side per fd"
recommendation but it was definitley the main precipitating event!
Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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