I don't think anyone has posted re: a recent (March 2006) research report on shields in the Journal of Obstetric, Gynecologic & Neonatal Nursing (JOGNN). The primary researcher presented her findings at the 2005 ILCA conference clinical day. The citation is:
 
Chertok IR, Schneider J & Blackburn S (2006). A pilot study of maternal and term infant outcomes associated with ultrathin nipple shield use. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(2), 265-272.

I don't think there is or will be an "absolute" answer re: when to introduce a shield. There can be times when it may be an appropriate intervention to suggest in the first 24 hours, though those times are probably rare and definitely other strategies usually should be implemented first. Tougher to answer when it's the 2nd 24 hours (24-28 hours) and some problem remains that is likely to resolve with just another day or two tincture of time -- yet the couplet is discharged home within hours and the mother is about to throw in the towel. 

Not long ago I was militantly anti-shield. I'm much less so now. Many times now I've seen it offer hope when a mother indicates she's lost it re: BF her newborn. No, it usually would not be a first line of intervention. Yes, proper instruction should be given that includes watching infant outcomes/outputs for both infant physical safety and maternal milk production. Yes, a follow-up mechanism should be in place. I don't practice in an ideal hospital setting and mothers' perceptions during a stressful period are not always completely reliable, so I'm not always 100% sure all these safeguards are in place for shield use once the couplet is discharged home. We provide a NS care plan that includes all these points and it's reviewed with shield instruction, and our out-patient phone is reinforced...

Addressing a different point that's come up in the discussion, I think with adequate inservicing experienced postpartum unit RNs could learn to assess for and introduce a shield under certain conditions -- and properly instruct a mother in its use until a LC could reassess. Again, circumstances may mean this better meets some couplets' needs at times when a LC isn't available.

I also think the shield is often one more option in a larger arsenal. If I go over a number of options and trying the shield is something that fits a particular mother's reality, she's more likely to give a good go than if I persist in an option that may add to her stress but she tells me she'll use it just because she think that's what I want to hear...

Karen

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html