I don't have moms do both at the same feed. My experience is that, in the
absence of an ample supply the shield is useless or worse, and in the
presence of ample supply it's not necessary to pump after. Generally, I
would never send a mom home with a shield and a colostrum supply. I would
send her home with a pump and tell her to come back when she has plenty of
milk (ie. at least as much as baby is taking.) Once her supply is ample, I
would

1) Introduce the shield. At first we use the shield every other feed (with
a bottle of EBM at the alternate feed.)
2) After 24 hours we have a very good sense of what's up based on feeding
and pumping pattern.
3) After that, we make a plan of care that will either be:
      A.  all shield feeding and gradual progression to the bare breast, or
      B. less shield feeding with gradual increase based on baby's
responses.
4) I am also fond of advancing shield sizes if the mom's nipple will
accomodate it. So I may begin with a preemie shield and advance to a
newborn, and then to the bare breast.
5) A good way to gradually move to bare breast, I have found, is to start
the feed with the shield and then take it away mid feeding.

Susan Keith-Hergert RNC, MS, IBCLC
Cincinnati







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