hi 

Veronica,

At my hospital, the staff nurses can and DO start babies on shields, both in NICU and Mom-Baby. We have trained the staff quite a bit on the risks and  benefits of shield use.  As you are well aware, there are multiple trade-offs.  Our policy states that a shield should not be used within the 1st 24 hrs, but this is frequently ignored by staff RNs.  sometimes that's a good thing, as in a case of a  term baby whose parents are chafing to get out the door, and might not have gotten any effective feeds if the shield had not been used.  it also gets started inappropriately, when staff is just impatient to get the baby on.  Reverse Pressure Softening is a big help, and it is my goal to get it into policy and train all staff how to do it within the next year.   

  As LCs, we make it our business to observe feeds on every baby who is using a shield, and make sure it fits and that baby is drawing the breast well into the shield enough to get some milk transfer going.  We also give the moms a printed page that tells them how to wean off the shield, that they should be getting weekly wt checks, and that they should see an LC within 3-4 days post discharge to evaluate their situation and begin shield weaning ASAP.  

  I think our handout also tells them if they lose their shield to get a replacement from an LC, and not at the store.  Molly Pessl said in a talk I heard her give last year that she had a FTT baby whose mom had replaced her hospital-dispensed shield with an old "mexican hat" style one that she bought at a local drug store!

Martha Johnson Rn IBCLC

Eugene Oregon, where we are finally having a normal winter with buckets of rain



-----Original Message-----

From: Veronica Carter RNC IBCLC [mailto:[log in to unmask]]

Sent: Thursday, December 11, 2003 1:57 AM

Subject: Nipple Shields and Pumping Question





I would love your collected wisdom and opinion on this...........



I am an LC, & RNC working in a hospital with a large NICU and

Continuing Care population (Growers and Feeders with assorted

premi stuff).



One point 5  LC is on to cover post-partum, Nicu, ccn, pediatrics, calls

and out-patients.



For the premi population nipple shields are very often used. I have

seen mothers faces light up when their baby finally gets a latch and

she feels the tugging of her nipple and subsequent milk left in it when

baby comes off. Up to now it has been only the LC who can pass out

shields to mothers. The LC is doing the teaching and covers the need

for continued pumping.  After discharge the LC maintains phone

contact and will do weight checks if needed.   The hospital has the

goal to push these kids forward toward discharge and they need to be

eating.......if not by shield, then by bottle.



NICU wants to have the authority to give out shields to their mom's

when they think the time is right.

Given the shortage of LC hours, it will happen.



I have been charged with inservicing the NICU staff about shield use

etc.



NO question, these moms will  need to pump.  Do you know of any

guidelines?  Do you know if nurses in other hospitals do this?  Are

people getting consent forms signed by the mother when shields are

used?



What are others doing?



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