Marie asks for opinions on nipple shields - if you have 10 BFCs, you will 
get 11 opinions!   The golden rule of any form of counselling is never say 
never.
The nipple shield is a tool - used wisely it may keep a mother on track in a 
situation where she might give up.  Used unwisely in maternity departments 
where sometimes staff assume that no mother has perfect nipples and no baby 
can get nourished solely on colostrum in the first two days, it can cause 
untold problems.

From my experience, for a mother to pump milk or express into a spoon or cup 
in the first few days is hard work.  And until the hormones are really 
stabilized, pumping can be very disappointing.  We know the baby only needs 
enough milk to fill up that marble-sized stomach, but when the mother sees 
the few tiny drops trickling into the container, she may lose confidence in 
her ability to produce enough milk.  And giving the milk on a spoon or in a 
dropper doesn`t do anything to strengthen the baby`s sucking instinct.

My own approach is to do everything to get the mother comfortable and the 
baby well latched on.  If that doesn`t work, then try the nipple shield, 
reinforcing that this is a temporary measure, and if that doesn`t work then 
pump or hand-express.

My classic case study was of a mother who had happily breastfed her first 
and second babies for more than a year.  Then when the third baby was born, 
she had problems she had never experienced before.  There were various 
external circumstances including extended phototherapy for jaundice and a 
small tongue (not tongue-tie)  that made it difficult for the baby to latch 
on and the mother had a persistent thrush condition that made every feed an 
experience of agony.  While we sorted out all the problems, she used a 
nipple shield - within a couple of weeks, baby was feeding well, nipples 
were healthy and bf was painless - so she threw away the nipple shield and 
continued to bf for another 15 months.

Wendy Blumfield
NCT-trained ANT Tutor/BFC
Israel Childbirth Education Centre

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