Denise,
  Wouldn't you think that if a shield worked for the preemie who is
even weaker and more sensitive that is should certainly work for the
stronger, more developed full term baby?
   I use the shields quite extensively and have kept records for
several years on the length of time on shields and duration of
breastfeeding (along with notes on each mom).  In the last several
months, our nipple shield use has gone sky high.  I do not want to use
the shield.  That is my first committment. It is a lot more work for me
and puts out bad viges in the community that is not yet updated as to
the new information out about the shields.  However, the need seems to
be increasing.  This just doesn't make sense. This has led me down the
path of what could be happening in L&D?  In the last 6 months, our
standing orders in labor have changed so they have added Fentynl to
their "Nubain cocktail".   What is happening to our babies?  I had a mom
and baby in for an Outpatient visit last week.  Her first baby nursed
without problems for about a year.  This baby, at 2 weeks still is
sleepy, disorgainzed suck and not gaining well. (Shield used for
inability to latch by discharge about 46 hours).  She had this new
"cocktail" and then an epidural which she did not have with her 1st
baby.  I am about to set up a study to see what is happening.
      Paula Meier reassured me that if a baby in the NICU is not
drawing enough milk from the shield (as happens at times) it is usually
a technique problem and can most often be corrected with better
positioning.  I would also have to add what Barbara Wilson Clay has said
about the sucking mechanism at the breast and some babies cannot
properly extract milk from a thicker breast/nipple (something like this,
sorry Barbara if I have misquoted badly).  So we seem to have several
things involved here.
     I would like to ask, how many babies do we see that can't make
breastfeeding happen without a shield anyway?  Or who have weight gain
issues and never have used shields? Or how many still have wt gain
issues when the shield is removed? Or how many have been scared into
getting off the shield and now babies can't nurse at all or are now
having wt gain issues?  We never hear much about these babies.  I have
had several in my practice.
   My concern about blaming the shield for every problem is the  baby
is not observed at the breast.  "Take the baby off the shield ASAP" is
taking the place of listening to the mom and watching the baby nurse and
often missing another problem. Most of the babies who come back in with
problems with weight gain I have corrected with changing the positioning
at the breast.
  I had another mom who nursed her first baby without problems for 9
months.  This baby was making her nipples so sore right away in the
hospital, she was about to quit.  A shield was offered by my partner.
The pain was somewhat better but mom thought she might have to pump. She
was instructed to pump 8x/day to heal nipples and try baby back on the
breast in a few days.  She came in on day 8 reporting baby had been
bottle feeding 3 oz each feeding and she had been pumping only 3-4x/day
and getting only 1 oz.  I weighed baby before and after nursing and he
got only 1 oz at breast. 2 days before our visit, mom quit pumping, quit
supplementing and had baby back on the breast only.  She would not have
been able to have him there without the shield because of ongoing pain.
His wt was down, history taking pointed to thrush for mom and baby. I
called the nurse practitioner who was kind enough to treat over the
phone but immediately added "tell the mom to get that baby off the
shield ASAP."  This is a typical example of blaming the shield instead
of looking at the problem.  Mom had not been pumping enough, she never
had a full supply, not because of the shield because she hadn't even had
the baby on the breast for 6 days!
   There are a lot of things to consider and look at than just the
outcome of milk supply with or without a shield.
  Jane Helgesen, RN, IBCL
  Mpls area

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