A tip of the iceberg sampling from LN archives:
6 July 1998: In a message dated 7/5/98 6:09:10 PM, someone wrote:
<<elevated risk of mastitis from the use of nipple shields. >>
DTobin "It is my understanding and experience that this is one reason that
pumping is recommended after (hopefully temporary) shield use - to decrease
the likelihood of mastitis.">>
6 March 2002: DTobin "I remember this topic coming up often,
there are many post in the archives on nipple shield use, some of which will
have the details and be helpful to anyone wanting to write a policy for
their
hospital. Barbara Wilson Clay's post comes to mind presently.">>
For More on the appropriate indications for use, see archives for this post:
From: Jim & Winnie Mading [mailto:[log in to unmask]]
Sent: Friday, March 28, 2003 3:56 PM
To: EDG; [log in to unmask]
Subject: Re: Nipple shield use in the first 3 days pp>>
29 March 2003: In a message dated 3/28/2003 9:46:52 PM Eastern Standard
Time, Jan B writes:
> So except for one pumping study (KGA) and one premie study (PM) I'm not
> sure there is another valid study out there looking a milk reduction w/ a
> silion shield. ????
DTobin "how about":
In a message dated 3/27/2003 6:45:36 AM Eastern Standard Time, Denise
Fisher
wrote:
> I've previously reported in Lactnet on a study of thin silastic nipple
> shield use over a 12-month period at a major Sydney hospital where
> excellent lactation consultancy and follow-up occurred for every case. Of
> the infants who were fed with a shield (assume excellent teaching), 47%
> either didn't gain weight or lost weight between hospital discharge and
> follow-up at 11 days. Of the 53% who gained weight the gain was 25g to
> 300+g. So even some in the weight gain group were marginal - though some
> thrived. (For more details of this study search archives using my name
> (not email, I've changed it) and 'nipple shields' going back to the
> beginning of 2000)
25 April 2004:
In a message dated 4/25/2004 2:07:48 PM Eastern Daylight Time,
[log in to unmask] writes:
<<<<<<<Can staff nurses start a shield?>>>>>>>>>>>>>>>>>>>>>
DTobin "imo only *If/when* staff has been educated/inserviced/"checked off"
for
competency; which includes demonstared skill/ability to assess/eval for
appropriate
use, pt teaching, giving pt written info/guidelines/care plan for shield use
and documentation...then shield use should be part of the staff's yearly
skills/competency review">>
5 April 2006:
In a message dated 4/4/2006 3:58:37 P.M. Eastern Daylight Time, Ann G.
Cagigas, RN, MA(masters in Human Development with specialties in Lactation
and Adult Ed
from Pacific Oaks/Lactation Institute) writes:"I have used a nipple shield
on days 2 and 3 to get these babies to breast.">>
DTobin "In addition to recent posts, interested readers can find more
examples of
why and how NSs are used in the early days in the LN archives.">>
12 May 2010: regarding Paula Meier's study someone wrote<<So any use of the
shield must be accompanied by pumping afterwards.>>
DTobin "I agree absolutely, ... pumping after each use at least till
abundant
supply and wt gain, then may gradually slack of pumping while watching
supply,
....For hospital use there should be a policy, procedures, mandatory
education
of staff, and documentation of staff learning appropriate use and follow-up
planning." ...then someone wrote: <<Which lead to the question of why use
a shield when
nursing,pumping,bottle feeding is 3 steps, and pumping and bottle
feeding is 2 steps, while baby practices infant-led latch.>>>>
DTobin "Very Good question.....For some moms the extra step of practicing
infant-led latch with truly
uncooperative nipples/areola is too frustrating until that anatomy can be
improved.
For some moms, some reasons for shield use may include:
-getting some milk from the breast via a shield is better than no milk from
the breast without a shield
-feeding with shield provides some nipple stim and milk flow
-shield feeding may help truly flat, retracting, dimpled, inverted etc type
nipples to become more graspable, as might the pumping afterwards
-some moms feel better about having the baby somewhat *closer* to
breastfeeding than all bottle feeding
-babies get accustomed to breastfeeding positions
also, with some dyads, pumped milk can be SNS'd to/with the shield,
by-passing bottle feeding all-together. Some hospitals may have mom & LC
sign a mutually agreed upon plan-of-care
document for shield use. This extra documentation can highlight the
importance of **very judicious
and discerning use** and Prudently Planned follow-up.">>
14 May 2010:
DTobin "Those working with a wide population have seen plenty of great
outcomes
with proper use and too many bad outcomes with misuse.">>
Debbie Tobin RN, BSN
Fairfax County, Virginia suburbs outside the Washington DC beltway
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