I just feel compelled to address this subject.

It is time that we, as lactation professionals, STOP having to justify the use
of nipple shields, to ourselves and to others.

It is evident by the postings from Barbara and Kathy last week that we still
are not "there".  These were two of the longest postings I have read in a long
time.  Both were justifying the very appropriate use of nipple shields in
order to help a mom and baby reach their bfing goals.  If this were a
different topic, one could quickly say, e.g.  "suggest the mom feed ebm to
baby via p syringe"...end of message.  But in suggesting the judicious use of
a nipple shield, we need lines and lines of justification!

We have to assume that if an LC is suggesting a nipple shield, it is within
the realm of treatment for the benefit of mother and baby.  Why should she
have to defend this tx more so than another tx?  And it doesn't always have to
be a last resort...just as it is not a first attempt!  The key is to best help
our clients.

Take the following scenario:  Mom, 5 days postpartum.  Baby won't latch (could
be nipple confusion, bottles in hospital, inv nipples, whatever!)  Mom is at
her wits end, feels like a failure, worried about baby's low output.  Baby
angry and frustrated and hungry.

Mom could 1.  offer breast (further frustration and bad feelings--15 min.)
                 2.  pump her milk (20-30 minutes)
             3.  finger-feed (I have seen as much finger-confusion as nip conf)
                 or cup feed (some babies stop opening wide after days of cup fdg.)
             or offer milk at br (why will he latch now if couldn't before?)

OR Mom could offer her baby her breast with a nipple shield.  Baby latches on
and gets HER milk from HER breast.  Mom gets excited to see evidence of milk
in shield.  Baby gets full and falls peacefully to sleep at breast.  Mom feels
that maybe she just CAN do this after all!

I changed my outlook after a mom called me once when I was trying to help her
wean from a shield and asked what MY problem was!  She was happily bfing her
baby, baby was gaining beautifully...the only one w/a problem was ME!

Of course no treatment is the same for every problem, and I don't "push"
nipple shields on anyone (see, even I have to justify my case!)  But I wish we
could de-sensitize the issue and treat it like any other appropriate,
well-thought-out treatment used to help moms and babies stay together as a
nursing couple.

Of course, as Kathy says, we have to watch this mom.  I hope, and expect, that
we are watching ALL our moms to make sure that our care plans are working and
that positive outcomes are attained.  I don't "watch" this mom any differently
than any other client.

Thanks for letting me vent!

Diane DiSandro, BA, IBCLC
LC in private practice--Audubon, PA