Ann,
It sounds as if the nipple shield intervention is not working. If the baby
loses weight and the mother's supply dwindles when using the shield, then it
is not helping the baby access the milk, so what's the point? Possibly the
shield is the wrong kind, wrong size, or not used properly, but it sounds
like that particular intervention could be discontinued in favor of a new
one. At this point, even though the mom wants a quick fix (who doesnt'?),
what she must do is ensure frequent, adequate milk removal and alternate
feed the ebm to the baby. In the meantime, investigate baby's anatomy and
mom's, thorough history, review basics of positioning and latching, and
encourage a 'babymoon' or lots of skin to skin kangaroo care. The baby could
be finger fed or cup fed and kept on mom's chest/breasts most of the time
til the problem is figured out.
Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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