I respectfully need to disagree with any assumption that current nipple shields are safe, in terms of preserving mom's milk supply. We absolutely don't have enough research to show that they are safe. Knowing that prolactin relies on nipple stim, and knowing that the nipple shield sits between the nipple and the baby, we should be proving that this intervention does not cause harm before just assuming they are OK based on 'cases' or 'experience'. We have not done this yet. Current studies are too short in duration of time, and too small.
I don't feel that comparing them to old nipple shields is any way to justify them. People seem to talk about how super thin they are. Well, if you talk to several men who use 'ultrathin' condoms (which are certainly thinner and skin-tight as compared to nipple shields), they would rather not use condoms because the sensation is still not the same.
As medical providers, it is very important to not do harm. Because the nipple shield can be associated with a decrease in milk transfer, and/or a decrease in mom's milk supply, this needs to be shared with mom. This is called informed consent, and is considered a basic ethic in medical care. There needs to be a strategy to prevent this harm from occurring.
Personally, I see too many sad cases of moms in my lactation clinic who are referred to me for low supply related to prolonged use of the nipple shield. They were never given information about this risk, despite being given the nipple shield by a health professional. I feel they are overused, and I rarely find a need for them in my practice. However, for moms who do use them in my practice, I have them pump after feeding, and I follow the infant weight closely. If they have an oversupply, or over time (ie at least 6-8 weeks) supply and infant weight gain are fine as pumping is weaned off, then they have proven that they don't need to pump after feeding. But I always want moms to prove this to me, in order to keep her and the baby safe. From my experience, the drop in milk supply with nipple shield use is often seen after many weeks of use.
Anne

Anne Eglash MD, IBCLC, FABM
Clinical Professor, Dept of Family Medicine
University of Wisconsin School of Medicine and Public Health
Medical Director of UW Health Lactation Services
Co- Medical Director, Mothers Milk Bank of the Western Great Lakes




Date:    Tue, 3 Jun 2014 13:07:45 -0400
From:    "Mary Jozwiak BS, IBCLC, RLC" <[log in to unmask]>
Subject: Re: Nipple shield and maintaining milk supply

This is a conundrum that hasn't been adequately studied in the literature.  I became an IBCLC in the bad old days of latex nipple shields and the "I'd never use them" attitude most LCs and LLL leaders had (with good reason, with the shields available back then.)  I've changed my opinion of shields, due to newer materials, more experience and data that shows some babies who can't properly form a nipple or grab enough tissue to get milk for whatever reason (prematurity etc) often get better transfer with the judicious use of a shield. 

That being said, the decision to pump while using a shield is usually made on a case by case basis. I talk to the moms of preterm babies and those with precarious supplies about pumping, along with some manual nipple stimulation before nursing with the shield and pumping to help supply. Those with a good supplies and full term babies often don't need to pump, and we re-evaluate based on the baby's output and weigh ins, which I do frequently on many clients who need to use shields for any reason. 

Babies who are transferring enough, don't need supplementation, have good urine and stool output, are growing well and whose mom's supply is good usually can either wean from pumping slowly, or stop, if only pumping a few times a day. 

However, if mom's supply is precarious, or baby's output is less than adequate, or the baby isn't growing well, of course we need to increase input, and often increase breast stimulation and breast "emptying" to stimulate a fuller supply. These moms would need to pump according to their needs. 

In my practice, there is no one size fits all answer to this question. Whether mom needs to pump with a shield at all, or how much depends on HER and the baby's unique situation. 

Mary Jozwiak, IBCLC, RLC
Birthwaysinc. 
Board Certified Lactation Consultant and Postpartum Doula Chicago IL
Special issue (#2014-284)
**************************************************************

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

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