Remember Paula Meier's research on nipple shields and preemies and the article in JHL not too long ago about how mothers feel about shields.  I think one of the things that nurses should link up - if mothers use shields they very may well have to pump to keep up supply.  All premie moms in Paula's study were also pumping for their babies.  And Hartmann and company research showing that to maintain supply at a level, baby/pump has to remove 70% of available milk from reserve.  If shields reduce volume by 14% AND mom has an adequate but not oversupply, we can calculate that there might be a gradual decline in milk production.  I find this useful for some of my moms who are persistent over-producers.  Over a period of time their supply will become manageable with use of a shield and babies who react to high flow that comes with let-down in an over-producing breast will tolerate breastfeeding using a shield.  AND -- in the middle of writing this reply, in walks an outpatient with a baby at 6 weeks still on the shield.  Put the baby in biological position and latch with 175 ml taken at breast and mom very happy.  This was a case where shield was given and instructions,  but mom not set up for outpatient follow-up.  This is what I think is needed to bridge the gap.  We have to have follow-up on our patients.  My mantra is if we are using 21st century tools on a cave-man mom and baby, we need 21st century vigilance - until we can return them to the cave man mileu of trusting their bodies and their babies!  And that can apply to any situation where breastfeeding is threatened and needs a little help. 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Marie Pulito RN IBCLC
Sent: Sunday, May 09, 2010 10:04 AM
Subject: dilemma of nipple shields

I work as a postpartum lactation consultant in a hospital. My colleagues and I are trying to decide whether to take away access to nipple shields for staff. We find that the shields are often given out too quickly to "solve" latch problems that would go away as baby gets less sleepy (less drugged) and has more time skin to skin. My own practice has evolved into using nipples shields less and less. I'm working towards Jane Morton's approach of teaching hand expression and spoon feeding for those babies who won't latch in the hospital. This seems to help most babies become more interested in latching and feeding. 

I just came back from the Log Cabin LC conference in MA. I was pleased by the fact  that Cathy Watson Genna uses shields in her practice. Would love to hear from others who have opinions pro and con about shields. Would especially like to hear about other hospital practices or protocols for shield use. Do you think it is "better" to send a baby home nursing with a shield rather than sending a baby home not latching or nursing at all? I know it is a case by case decision. What are your thoughts?

Thanks in advance for all your wisdom!

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