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Subject:
From:
Susan Burger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 24 May 2005 16:40:35 -0400
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Cheryl asks about the nipple shields - and I feel I am on the receiving end of the use of nipple
shields for almost everything.  There is one hospital in Manhattan in particular that I feel like
almost every baby I see has been put on a nipple shield.  And for some babies this is just fine.
But for most it is not.

For some babies, mom's nipples were just fine to begin with - maybe a little flattened in the
hospital for the engorgement phase and, had there been adequate support (meaning really the
hospital having enough LCs to really follow through instead of not enough LCs trying to do their
best with what time they do have with each mom) these mothers might have been able to latch
and skip the shield entirely.  So, I blame this on hospitals not having adequate staffing for the
hospital LCs to really spend the time to exercise all their skills - not the LCs themselves.  If these
moms have a decent supply - I get the baby on and the nipple shield is history.

Then, I notice is that the shields that are used are 16 mm shields.  With many of these babies, the
16 mm shields are too small.  I always try the baby without the shield first and many times I can
get a good latch and sometimes I cannot.  When I get the baby on I watch for milk transfer.  If milk
transfer does not happen without the shield, of if the baby slips and slides off and cannot create
suction, I try the shield.  I have done experiments with even some of the little premie babies and
most do better on a 24 mm shield in terms of milk transfer.  I always watch the time and the
transfer and pick what works best.  I saw one big guy who took 45 min to take 0.6 oz with the 16
mm shield.  With the 24 mm shield he took 3 oz in 10 min.  Every now and again there is a baby
who is better on the 16 mm shield.

The next problem I see is that milk production is sometimes forgotten.  Many of these mothers tell
me that they were told not to pump or told to pump but forgot how often they should do it.  So,
milk transfer was not evaluated, baby's not really taking enough from the shield and mom's not
pumping.  Then I end up with a low supply situation on top of baby not gaining.  At which point I
toss out the shield and move on to other methods because I find it really doesn't work if you don't
at least have a decent supply.

What I think is needed is that hospitals should have a handout for moms using nipple shields to
have a follow up when the supply is really in to really test whether milk transfer is occuring.  I also
think that specific instructions should be given to mom to continue pumping to ensure that the
baby really is getting enough and the supply is stimulated until she is seen by an LC who can
assess milk transfer.  I also think that hospitals should consider using larger nipple shields than
the 16 mm which seem to really impede milk transfer.  Although I'm seeing these women on day
4-12, not day 0-3 when the picture might be very different.

I'm not sure what handouts Cheryl is using, but the other possibility is that moms really don't even
look at the handouts.  So perhaps that's what is happening.  I remember my foggy postpartum
state that I wasn't too good about reading anything.  So, who knows this might not work.

Maybe just sending the parents off with the message that they must see an outside LC or come
into the hospital clinic in x number of days for follow up?

Best, Susan.

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