In a message dated 5/12/2010 5:07:53 P.M. Eastern Daylight Time,  
[log in to unmask] writes:

<<<<I will be publishing a few articles on nipple  shields in Breastfeeding 
Medicine in the next few  months>>>>
 
will very much look forward to that.................

<<<<So any use of the shield must be accompanied by  pumping afterwards.>>>>
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. 
 
 

<<<<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.>>>>
Very Good question
 
For some moms the extra step of shield feeding is indeed too  much.
 
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
 
 
 
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.
 

 
Debbie Tobin
RN BSN IBCLC
Fairfax County, Virginia suburbs  outside the Washington DC beltway

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