Yes!!! My Dec JHL arrived just two days before Christmas so I put it with
all the other presents on our tree. At 1.15 a m on Xmas morning, long after
my family had gone to bed (and having finally caught up with writing notes
and reading Lactnet!) I could resist no longer and tore open the wrapper.
What a sensational issue! THANKS Kathy A. THANKS Barbara W-C and all the
other brave souls who had the courage to tackle the controversial issue of
nipple shields.
Sorry Dr Jack, but I too find that these little gadgets make breastfeeding
possible when all the other kinds of latching strategies have failed - for
the mother with flat/inverted nipples, engorged or inelastic breast tissue,
for the baby who has received pethidine during labour and appears confused,
for the baby who has a short/retracting tongue or a high palate or any
combination of these.
I accept that one of the fears associated with the use of nipple-shields is
that "nipple-confusion" will be created, but I am one of the disbelievers in
"nipple confusion" - the babies I see, and the ones I eventually consider
would benefit from the use of a nipple shield, have never ever been exposed
to a bottle teat before (all mothers are expected to breastfeed) and yet
they behave in ways that I have seen attributed to "nipple confusion", so I
prefer to call this a "latching difficulty". My observation is that both
nipple confusion and latching difficulties are the result of the baby's
inability to receive stimulation to the *palate*, thus a baby who has been
exposed to pethidine during labour, but whose mother has "easy" (long-ish)
nipples, or very elastic areolar tissue is less at risk for a latching
difficulty, whereas a baby with a high palate whose mother has
short/flat/inverted nipples is at higher risk. A nipple shield can elongate
previously flat nipples and can "create" a teat out of inelastic breast
tissue so that the baby who has a "normal" suck can eventually be re-latched
without the shield. So can a baby who has previously been exposed to
bottles if he can receive stimulation to the palate. If the latching
difficulty is the result of a *baby* problem (retracting tongue/high palate)
then a shield can "teach" the tongue to stay down, or can create a longer
"teat" which can reach up into the palate (and so can a bottle-teat) so
that, in time, the baby can "learn" what to do. When I read about "nipple
confusion" I always want to know what the mother's breasts are like, what
the baby's oral anatomy is like, and exactly what strategies were attempted
before this label is used. I think the term is too imprecise. It's all
relative.
Anyway, thanks to the Dec JHL and all the wonderful, experienced opinions so
well written up in ILCA's journal for lactation specialists, from now on I
will be able to express a little more confidence about the outcome when I
"resort" to the use of a nipple-shield to initiate breastfeeding in
otherwise impossible situations. Now it's not just *my* opinion - thanks,
everyone!
Pamela, Zimbabwe
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