We have a standing policy in our hospital that nipple shield are a 
*prescription device* and there are only available through the lactation 
clinic and the pharmacy.
Whenever I start one, the mother is told that it is a crutch to get over the 
current problem and the baby must be gotten off the shield ASAP
The written instructions they receive read as follows:
Nipple Shield: The nipple shield is a device with a strong potential for 
misuse.  It cannot be used long term.  Nipple shields can cut down on your 
milk supply and baby’s milk intake by as much as 40 percent.  Baby can become 
used to the shield as easily as to a bottle nipple.  The shield is a 
temporary measure only. 
Use the shield at each feeding for the next __24-48 _____ hours. 
a You must be seen in the lactation clinic in __3__days.  
b Keep a written record of feedings, wet diapers and stools each day. Bring 
the record with you to your appointment. [they get a specific form to fill 
out]
c Wean from shield by attempting to latch infant on without the shield or by 
removing shield mid-feeding.   
d Try but don't insist.  Don't fight with the baby.
e Rinse the shield in cold water immediately after use. Then wash with hot 
soapy water and rinse well after each use.  
f Pump for a minimum of 5 minutes on each breast after each feeding to 
increase breast stimulation

That said. I found that when I was working in our Great Starts Clinic I was 
using a lot more devices (shield, pumps and SNS) then I ever had. I of course 
used good latch-on and all my LC bag of tricks but found that I had to resort 
to using things I felt were taboo before. The moms at Great Starts are all 3 
to 5 days post hospital discharge and sometimes it was a matter of *get this 
baby to breastfeed right now or that's it!* The look on the mom's face when 
the baby latched on and peacefully nursed for the first time was always 
amazing. [BTW anyone who is started on a device at Great Starts automatically 
gets an appointment and if they don't show they get a phone call] What struck 
me was that sometimes these babies would right themselves in one or 2 
feedings. I have yet to figure out if it was the old confidence game or the 
fact that baby wasn't being stressed at the breast or age, or a combination 
of all those things.
We rarely start any intervention in the hospital, they aren't there long 
enough to get in the groove yet. We don't cup feed and we don't finger feed. 
The options are given to the parents but our client population chooses 
bottles. Which means we may have to deal with flow preference/nipple 
preference issues later. Our neonatoligist is getting or has gotten the Avent 
bottle for the OB unit (I'm not saying one bottle is better then another) but 
we seem to have less problems with flow preference/nipple preference issues 
with this bottle. But that is just my experience.

Checking in
I thought I should at least post because some of you have emailed me 
wondering how I am. My last surgery was December 10th (the 5th one of 1999). 
I am still wheelchair bound, have a semi paralyzed left leg, wear 2 braces 
One that goes around my waist to just below my knee, because the hip wants to 
dislocate, and the other brace from the knee down to the foot (If you saw me 
at ILCA in July it's the same setup) and continue to have a lot of pain.  In 
January, I stopped taking one medication that was sapping both my energy and 
my memory: Elavil.  It was like my brain was refusing to work. And I really 
felt that even though I was sleeping, I wasn't resting. Stopping the 
medication made for an increase in the pain from the sciatic nerve injury, 
and I spend several nights a week unable to do anything but cat nap but I 
feel so much better mentally.
I am at peace with the probability that I will not return to my LC practice 
as I once knew it. Direct patient contact is out of the question because of 
the instability in my hip. But I am planning on continuing to teach others 
how to be an LC and I have been doing a lot of Internet support with 
breastfeeding moms. I'm not totally out of the loop yet.
Love to you all,
Marie Davis, RN, IBCLC
http://sites.netscape.net/mariedavisrnibclc/index.htm 
      also at
 http://hometown.aol.com/davisrnclc/myhomepage/index.htm 

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