Jessica describes six frustrating calls in the last month where mothers have
been handed out nipple shields in the hospital, and suspects that she is
witnessing an epidemic!  My sympathies are with you, and the moms you
attempt to help - this does sound a bit excessive.

However, in defence of nipple shields, I have to confess I find them useful
in last-resort situations, after the mom's milk has come in, for those
hideous latching difficulties that seem unresolvable with any other method.
Although I work in private practice, I am lucky enough to do consults in the
hospitals and a baby who cannot latch cannot breastfeed, and a nipple shield
can act as a sort of shoe-horn to take the stress out of the situation,
buying a little time.  Unless you are able to see the nipples, the shape of
the baby's mouth, the mom's and baby's positioning and latching techniques
it is easy to blame the shield when really the cause of the trouble is
something to do with *breastfeeding*.

Intellectually, I happen not to believe in nipple confusion, but there's
always that nagging possibility that one day I'll meet a baby who really,
truly demonstrates it.  I thought I might have met her today, but no - once
again I was privileged to see first-hand, all over again, that we don't need
to be afraid of shields, or bottles, or pacifiers, we just need to get the
*breastfeeding* (positioning/latching) right!

My new client had a 3 week old exclusively formula fed baby who had stopped
breastfeeding at 7 days of age.  Mom was interested in relactating/resuming
breastfeeding.  During the first week this poor mom suffered cracked
nipples, then what sounded like a bacterial infection of the nipples,
extreme pain, nipple shield use, then mastitis.  At this point she abruptly
weaned and put the baby on formula, fed by bottle.  Mom was quite sure that
the original cause of her sore nipples was because they were flat, and a
breast exam confirmed that they were indeed quite a "difficult" shape.  So
this 21 day old baby had been fed by bottle for the last 14 days, and by
nipple-shield for the four days before that -  for 85% of her life - and the
nipples were flat.  Not great.  So I went very carefully through the
positioning, how to hold the baby, how to present the breast, how to achieve
the latch.  Bingo!  Baby latched, baby sucked.  I almost couldn't believe
it.  We reviewed it several times, both breasts, just to reassure the mom
that this would be possible.  Best of all, she kept commenting to her own
mother (a former midwife, no less!) and her husband, who were both watching
*very* closely, how *comfortable* it felt to breastfeed the baby - nothing
like the first few days.

Jessica, this is your opportunity to waltz in and rescue triumph from the
jaws of disaster. You could offer yourself for a post-discharge follow-up.
Babies who have become used to shields, or teats, or dummies *can* be
seduced back to the breast.  But I do remain convinced that you have to work
along with, or even around, the mom's and baby's individual anatomical
characteristics, and tailor their technique accordingly.  Personally I love
these situations.   The moms have always heard dire stories about nipple
confusion and you have a unique opportunity to blow them clean out of the
water, to rescue the breastfeeding and enhance your reputation all at the
same time.

Pamela Morrison IBCLC, Zimbabwe

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