I just want to add a few more comments to this discussion. I strongly
believe that a full assessment needs to be done of the situation before a NS is
introduced. The likelihood that the staff nurses can do this is very unlikely.
If a baby is not latching I give my staff alternative to try such as; lots
of skin to skin, hand expressing, spoon feeding the express br milk, syringe
feeding, or cup feeding. They do not have access to the NS. Sometimes the
baby just needed some extra time to recover from birth and than they start to
get interested in latching and sucking.
Next, I strongly disagree with early introduction of the NS. This would be
the first 1-2 days, especially the first 24 hours. The baby's mouth needs
contact with mom's skin. This is so important and would be lost placing a NS
for the baby to suck on. Also, in the first day or two is when the nipples
are flatter and the areola can have edema. These nipples do not get deep
enough into the NS. Having these moms hand expressing and using RPS as needed,
gets the colostrum for the babies and works the nipple out.
Regarding the different sizes. I have used the 16 mm on little preemies and
they have done the best with them. The larger sizes just were too big for
their little mouths. I have used the 20 mm for the smaller, near term babies.
Barbara Wilson Clay has addressed NS sizing by the baby's mouth and I have
found this very useful. Most moms can stuff, squeeze, and smash their
nipples comfortably. Look at what we do to ourselves with bras, clothes, and those
few who pierce their nipples. If a mother finds the NS uncomfortable, then
this may not be the correct tool for her to address the problem, so you go
back to the drawing board to find another approach.
We cannot just say "getting the baby on the breast" is the only goal.
Ann Perry, RN IBCLC
Boston, MA
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