Veronica writes:
I have been charged with inservicing the NICU staff about shield use
etc.

NO question, these moms will  need to pump.  Do you know of any
guidelines?  Do you know if nurses in other hospitals do this?  Are
people getting consent forms signed by the mother when shields are
used?


I, too, have a problem with nipple shields being given out inappropriately by nurses, usually for a mom with "flat" nipples as dx by them. The pat answer when I object is it's either that or a bottle as they don't have the time/skill to try and get the baby on the breast).  Technically only the LCs are supposed to give them out but we have only 1.2 FTEs allotted for nearly 2000 deliveries per year plus Peds, SCN, outpatients and call-ins and currently .6 of that is unfilled (you guessed it, that leaves only yours truly). Routine follow-up calls aren't even on the menu so to speak.  As for the NICU, I try to encourage the moms and/or nurses to give the baby plenty of trials of going to the "naked" breast.  I generally (making allowances for anatomy and corrected age etc) don't introduce the shield until it becomes and issue of the baby taking full nutrition at the breast and it has been shown that s/he cannot do so at breast alone.  The nurses in the nursery are pretty good at following this criteria (with one or two exceptions).  We do not have mothers sign consents for nipple shield use.  I am supposed to be alerted to all such babies but I do miss some.  The key here is making sure that the nurses are all on the same page in terms of what constitutes appropriate use and proper education.  Perhaps put up a poster of some kind addressing these points.  I did a short presentation for nursery about supporting breastfeeding in the NICU which included appropriate ways to bottle feed (paced feedings etc) and put up a poster by the back nurses station as a "reminder."

Good Luck,
Stacy Miller-Leonard RN,MS,IBCLC
Chicago suburbs

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