LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
Christine Staricka <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 10 Feb 2014 12:34:01 -0500
Content-Type:
text/plain
Parts/Attachments:
text/plain (26 lines)
Nikki, thank you for that excellent and concise list of shield explanations.  Jane, I agree with your observations and overall impressions as well.
I would like to pose this for discussion: what is the rationale for using a shield with a non-latching, non-suckling, or poorly-suckling baby prior to the onset of Secretory Activation (Stage II Lactogenesis)? In my opinion, the onus of proof is on the intervention; in this case, the silicone nipple shield.  How does it improve the situation and where is the evidence which proves it? "It makes the mom feel better and breastfeed longer" does not stand up; we have seen a systematic review of the existing published evidence and it does not bear that out. (McKechnie & Eglash, 2010.). That same review also did not find that shields improve breastfeeding outcomes for premature infants, even though many in the field have anecdotal information that it did improve outcomes.  If we are to practice evidence-based information, we will need to balance what has actually been researched and published with new, emerging information which has not been around long enough or does not have funding behind it to provide research yet.  Nipple shields are not new.  They are tested.  There are so many theories floating around out there about shields, and everyone has their own level of comfort in recommending them.  In addition, some mothers simply do not like using them, whether because they dislike the feel, resent the barrier between themselves and their baby, or because they still have to pump after they feed, so they are not a viable option in some cases.

I have based my entire hospital-based practice as well as my First 100 Hours postpartum strategy on the basis of supporting infant intake only at the breast or with expressed breastmilk via alternate feeding method appropriate for the age and behavior of the infant.  The more knowledge we gain, and this body of information is growing rapidly over the past few years, the more we understand why a baby might not latch, might not latch well, might not suckle, might suckle poorly or weakly, might be unable to suckle, might be unwilling to feed at all.  Looking for those reasons or explanations and helping parents to understand them is infintely more thorough, ethical care than grabbing the nearest piece of plastic and using it as a tool.  Find the possible explanations, explain them to the parents, support infant intake, protect milk supply - that is informed consent.  I do not see any benefit from adding a shield to an equation where there are already so many confounding factors.  Like ready-made formula, bottles, artificial nipples, and pacifiers, the cost of nipple shields has been kept low for ease of use in the early postpartum hospital situation.  Coincidence? If they cost $50 each, would they be so readily distributed? If manufacturers really wanted them to be used as individualized tools for specific situations, they would not be selling them as retail items in big-box stores to new parents.  (As an aside, when I purchased 2 brands of nipple shields at retail price from my local big-box store for demonstration purposes in the courses I teach to professionals, the register spit out the biggest coupon for formula I have ever seen.  Both the receipt and the coupon are part of my display.)


I have seen shields used by hospital staff in an effort to "be the hero" - they got the baby to "latch" when lactation staff "couldn't." I have seen  hospital staff send families out to buy them  for babies already assessed by lactation staff because "lactation wouldn't give them one." I have seen mothers buy them and use them and call with desperate pleas to rescue their dwindling milk supplies.  I have also seen mothers buy them, use them, and transition baby off with little assistance.  I have seen a 7-month old with Failure to Thrive be hospitalized for 3 weeks and his parents investigated for neglect, all the while mother was afraid to mention she uses a shield for breastfeeding and by that point had minimal milk.  I have talked to women who unabashedly share their "victory" stories about shield use with their postpartum friends and family in the hospital, whose stories really trail off at the end when I ask gently about when they weaned because, well, it turned out they "couldn't make enough milk."

Who among us does not have that list of stories? Today we have SO MUCH MORE INFORMATION about the reasons babies have difficulty breastfeeding.  I feel like we need to keep this conversation going and work on a consensus opinion.   Ours is and has always been an evolving field.  As we work to increase our credibility and reputation for excellence in care, let us strive to always incorporate new knowledge and adjust practice accordingly, while never stagnating or sticking with "the way we've always done it." People are doing amazing work on so many lactation topics: mental health, anatomy, milk supply, hormonal issues, maternal motivation, cultural practices, impact of birth practices, use of donor human milk, infant structural issues, ankyloglossia, lip tie, prematurity, infant positioning and biomechanics of breastfeeding, etc. I hope we can always keep shields around for the cases where we really feel they can be used appropriately and under the care and advisement of an IBCLC.  I hope we also can always maintain a healthy reservation about using ANY tool or piece of plastic (pump, bottle, nipple, SNS, etc) without serious consideration.  

Christine Staricka, BS, IBCLC, RLC, CCE
[log in to unmask]
www.first100hours.com
Bakersfield, CA

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome

ATOM RSS1 RSS2