Dear all,
A main point that I was hoping to share is that moms who are given a nipple shield must have informed consent. So in the scenario shared below, where mom is given a nipple shield at WIC and the baby latches on, I would disagree re not giving a pump if the supply is fine. She is about to change her physiology by using a nipple shield, so milk supply at moment in time may change with the nipple shield. 
I would give her a pump, ask her to pump afterwards (unless supply is excessive), and have her prove that she does not need to pump post-feeding by having close follow up, with infant weights and assessment of milk supply. If the population is too transient and unreliable to follow up, then  mom should be given a pump anyway, and instructed on the risks of a nipple shield, ie risk of decreased milk transfer and decreased maternal milk supply due to blunted prolactin levels. Knowing what we know and don't know, withholding info on risk is unethical.
Anne


Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director of UW Health Lactation Services
Co- Medical Director, Mothers Milk Bank of the Western Great Lakes
608-437-3064
600 N. 8th St.
Mt. Horeb, WI 53593




Date:    Thu, 5 Jun 2014 13:33:38 -0400
From:    "Sue Jacoby, IBCLC" <[log in to unmask]>
Subject: Re: Nipple shield and maintaining milk supply

Working in a WIC office can really give one a reality check on what can be done to get mothers and babies breastfeeding.

In a community where 70 percent of mothers exclusively formula feed, (I know, it’s horrendous) the remaining moms are working against all odds to give breastfeeding a “try.”  What the nipple shield can do is give them an experience of what a good latch feels like, and a realization that their newborn actually DOES know what to do.

Almost every day, a mother will visit her WIC office with her newborn, asking for formula, because her baby can’t or won’t latch on.  When I help these pairs, if the baby has never been given a bottle, the laid back style of latching almost always works like a charm.  I still marvel at how much easier it is for the baby, and I have a photo of the first mother I ever helped with this “new” approach.  She had terribly cracked and abraded nipples, and was pretty scared to let the baby try again.  But the minute we gave him the chance to crawl over to the breast on his own, he latched deeply and after the mother was finally able to drop her shoulders and enjoy the fact that she was not feeling any pain, she was thrilled (as was I!)

But if the baby has been getting bottles since almost day one, as have the great majority of the mothers who come in to WIC from our local hospital, I find that the nipple shield is often indispensable.  I always give the baby a chance to show what he can do- and again, most crawl to the breast just fine- which is the first big revelation for the parents… “Look what your baby can DO!”  This gets their attention, and then the baby MAY latch, but often the baby has very little patience for the efforts we make to help him, and I always know I am in a bit of a race to keep mom engaged, and to keep baby from falling apart.  Thus, the nipple shield.

What the nipple shield provides is a chance for the baby to convince the mother that he CAN do it.  She feels the latch.  I literally sit and watch the hormones start to work.  Now, we have a chance to turn things around.  Baby learns where the food comes from.  For a certain percentage, this is enough, and they can go on to work with their babies to full breastfeeding, sans the shield.  I may or may not issue a pump, based on my assessment of mom’s supply.  

I think for some mothers, the shield gives them the experience, but they remain too overwhelmed or scared to trust breastfeeding.  For these mothers, I think the shield has made a valuable contribution anyway.  Because next time, mom will have a better sense of knowing that it is actually possible for her babies to latch to her breast.  She has felt it.

Sue Jacoby, IBCLC
California
-287)
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