I agree with Susan Burger that we don't need to make blanket 
recommendations for pumping when mom uses a nipple shield, just like we 
don't want to make blanket recommendations about pretty much anything 
without a good assessment, and then we individualize our recommendations 
accordingly.

I too use test weights to confirm whether a baby does well with the 
shield or not, and I don't let moms keep the shield if it didn't work 
well. In my most impressive case, a baby with torticollis and a very 
asymmetrical mandible (it was at a 45 degree angle to the maxilla on the 
shorter side), the baby transferred 0 without the shield, and 3 oz (85 
ml) from one breast with it! If we made that poor mom pump, she would 
have developed an oversupply.

Moms using nipple shields do require careful counseling. They need to 
know to watch baby's behavior and diaper output, and how to intervene 
quickly if baby needs more milk to avoid their milk production dropping. 
They can be taught to count stools and watch baby for excessive 
sleepiness or fussiness and start pumping and giving extra milk 
immediately, and come back in for a follow up as well, if they see 
adverse signs.

The big problem with the 'medicalization' of lactation consulting is 
that there is a push to 'protocolize' everything. Natural systems that 
involve two individuals have so many variables that this is difficult to 
counterproductive. While it is vital to understand the system design, 
function, and interactions, it's not possible to have a one size fits 
all solution for each potential problem. Just one more reason why it 
takes a long time to develop true expertise in this field, and why our 
mentoring programs are so valuable.

Catherine Watson Genna, BS, IBCLC  NYC

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

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome