In a message dated 2/21/0 11:18:21 AM, Jack writes:
<< I do see young babies, under three days of age, though not as often as
hospital based LC's, but I can tell you that with practice, you can get many
of these babies on the breast and breastfeeding by getting them on with a
lactation aid after a minute or two of finger feeding.>>
Dearest Jack, you know i am of the opinion that you are always right in the
end, but, till we get there, i will comment that, with almost 10,000 (many
multicultural) babies a year where i work, i guess we do see lots of mild and
moderate, and many serious nipple/breast variations, which are of the
"latch-defying" type, ie: no amount of finger-feeding the baby would have any
effect on making those nipples at all protractile/those breast at all
graspable.
<<You hospital based LC's mustn't forget those of us that are faced with a
mother of a 7 or 10 day old using a nipple shield.>>
based on other recent post, by other lactnetters who see the rare shield use
as the last ditch effort to keep bf an option that the mom will pursue: maybe
without the shield you would not be seeing them at all because they would
have given up all hope of bf and would be bottle feeding formula. (?)
also, many hospital lcs see moms for postpartum consult visits/groups, so in
some cases they are in the same challenging boat with you, with that 7-10 day
old that needs f/u and continued management.
<<It is my feeling (not proved) that it is easier to get a baby latched on
who has been on a bottle than on a nipple shield>>
this is a good research question. i personally am undecided about this, but
leaning toward shield. also, some practitioners use a shield briefly to pull
nipple out then slip the shield off and work on latching baby onto the more
protruding nipple. sometimes this works depending on degree of variation.
<< A nipple shield can seriously interfere with milk supply, since often the
baby
is not really stimulating the breast,>>
agreed. this is why pc pumping and supplementing expressed milk is important
to initiate from the start.
<<The exception is when nothing else has worked,...>>
yes, agreed, the only case in which to use a shield.
<<...I will often start the nipple shield when the baby is 2 or 3 weeks of
age. This seems to change something for many babies and then they latch on
after a week or so on the nipple shield.>.
so, "when nothing else has worked", in these infrequent cases, the shield is
a good transitioning technique/strategy to breastfeeding
<<..I do not do this very often, even though I see many many babies who don't
latch on, often 5 or 6 in a single day. Because with good latching technique,
most babies will latch on. >>
agreed, many hospital lcs are up to our eyeballs in babies who have
difficulty latching, who will not, or who cannot latch, and consequently in
hospitals the lc becomes known as the "latch-on queen", until all the staff
is up to speed on good latching technique.
<<I still maintain that starting a nipple shield before the mother's milk is
abundant
is poor practice, since it does not give time a chance.>>
for the infrequent not-latchable new baby early postpartum, before the
mother's milk is abundant, my understanding, from your post, is that
bottle-feeding formula, is better than baby using a shield and being
supplemented formula with a shield in place.
a question then: after discharge from the hospital, are those bottle-feeding
moms more likely than shield using moms to pump enough to establish an
abundant supply?
warmest regards,
Debbie
Deborah Tobin
RN BSN IBCLC LCCE
Springfield, Virginia USA
In the suburbs outside the Washington DC beltway
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