When nipple shields are chosen appropriately and used properly, mom
might not have to pump at all, and generally does not have to pump after
every feeding.

The nipple shield must fit the mom's nipple and the baby's mouth
properly, baby must be able to get a deep latch to transfer milk.  If
baby gets as much milk as he needs to stool 3-5 times a day or more, mom
does not need to pump.
The nipple shield must be applied so that the nipple is drawn deeply
into it.  Linda Pohl has a wonderful method:  she turns the teat portion
halfway inside out, puts the little dome portion over the nipple, and
has the mom press the shield inward toward the breast with her fingers.
  The teat portion "pops" out, drawing the nipple with it, and bringing
a lot of breast tissue into the shield, so the baby's jaws and tongue
can compress the breast, not the nipple.
The baby must latch onto the breast, not the shield.  One can use an
asymmetric latch technique with a shield, it works very well.
Finally, the LC needs to assess the baby's sucking effectiveness and
intake, and help mom learn the same:  suck:swallow ratio, rythym and
burst length, open-pause-close jaw movement pattern indicating nutritive
sucking, swallowing, etc.
If all the above is done, the mom might not need to pump at all.  I
stopped instructing moms to pump all the time when I noticed a lot of
shield using moms were having plugged ducts and oversupply problems
because of that advice.  Again, we ALWAYS need to assess the individual
mother and baby and individualize our care plans.  THat's the one
absolute in this profession.
There, end of sermon. ;-}

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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