Dear all:


Jane asked about the promotional shields that she has not seen.

First, I want to make it clear that I am generally against distribution promotional samples 
through hospitals unless very strict standards and complete transparency about potential 
conflicts of interest are in place. I'm speaking about ANY promotional samples in hospitals 
- not merely products for infant feeding. It is a murky opaque world to the consumer.  I 
have no idea how decisions are made.  Since I do not work in a hospital and do not every 
want to, this question may seem naive and it is because I really don't know.  Do hospitals 
have transparency about how products are selected and which companies are giving 
donations? Some of the reasons why I am against it are as follows:

1) The misperception that these samples are free may lead to a selection process that 
weighs the cost to the hospital against the needs of patients.
2) Samples may result a selection of only one "average" product, such that clients who 
have different needs than the "average" may not have access to the best products for 
their needs.
3) Even if the hospital doesn't pay for the product, consumers pay for the product through 
the increased price to cover distribution of these samples.
4) At least in Manhattan, there seems to be a system of "exclusivity".  Allowing one 
company to distribute their promotional samples to the exclusion of others.  This limits 
choice
5) The consumer who must use the product ultimately pays for the distribution of 
promotional samples through higher cost.

And I'm speaking about any product in hospitals. It is a murky opaque world to the 
consumer.  I have no idea how decisions are made.  Since I do not work in a hospital and 
do not every want to, this question may seem naive and it is because I really don't know.  
Do hospitals have transparency about how products are selected and which companies 
are giving donations?

That having been said, the specific product is a shield that has a slightly different shape 
than other shields.  You cannot screw a hand pump to the back of this shield.  In the 
place where you would a threaded area where you either put in the tubes or screw on the 
hand pump --- you have a bend with a small part that sticks up where you insert the 
tube.  The tubing is thinner.  It is not a two piece system that makes it easy to stick them 
through a home hands-free pumping bra.  When it is a one piece system you have to cut 
larger holes through the bra to fit the whole piece through the hole rather than just the 
cone.  These are given out from several hospitals.   Mothers are not informed that these 
are "test" or "starter" products until you buy your own.  I don't know if they were 
intentionally designed as "use for the duration of the breastfeeding problem" products.  
Mothers tend to continue to use these for the duration, unless I come alone and notice a 
problem and suggest they shift over to what I consider "use for the duration of the 
breastfeeding problem" products until we can fix the problem. 

It was a mother who claimed that she was told the opening was 23 mm, not 24 mm.  I 
have not verified this.  My observations of milk yield and pain are based on many clients, 
not this one mother.  I have not done a "clinical" study.  These are clinical observations 
among the population of mothers I see.

Most mothers think of the "starter" SNS as a "use for the duration of the breastfeeding 
problem" product as well.  In my opinion the tube is way too short and it clogs up quickly.  
After about three to five days at home, I find many babies cannot get enough milk out of 
the tube because it is clogging up.  The tube is ridiculously short --- so you can't do all 
the innovative things you can with a Jack Newman's bottle --- like put it on a night stand 
while you semi-recline in bed half asleep -- or with a syringe and long feeding tube like 
one dad who wrapped the syringe with a rubber band (standard instructions I learned) 
and hooked it with a paper clip through his earring hole or another dad who taped it to 
the back of the rocking chair.

Best, Susan Burger

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