I am a new responder but old reader to LactNet.  I am a full time hopsital lactation consultant in the Mpls area and have been IBCLC for 13 years.  I have been following the postings and experiences of others about the usage of the breast shield.  Quite some time ago, I believe it was Barbara Wilson-Clay who discussed the importance of baby getting onto the shield properly in order to get the best transfer of milk and the resulting sufficient milk supply.  After I read that, I watched.  I found that when babies get onto the shield completely, most moms do not have a problem with their milk supply. If the milk supply is poor, it is usually because baby is improperly placed on the shield.   So our old information was based on the nipple shield causing a reduction of the supply not that the improper placement causing the problem.  This has been born out over and over for me.  So is it necessary to tell a mom that the shield may cause a decrease in the milk supply? or would it be more accurate to say: " when we use a shield we want you to pump until a good supply is established and baby is gaining weight". We have had a policy to have all moms pump after each nursing until the baby is reweighed and is gaining.  However, sometimes I see a lot of milk in the shield, baby is obviously gulping and I feel extra pumping is overkill.  What do you do with the colostrum pumped if baby is content after nursing?  So far I have the parents cup feed all the colostrum and then freeze the extra breastmilk for later.
  Now about the preemies.  I have taken Paula Meier's research and actively used it in our LV II nursery.  I have seen amazing results.  The good thing about my work is I follow up with the moms once baby is discharged to see the results. Before, I had no need to call so never knew how the preemies were doing.   I keep track of all of this on my computer in excel.  You can go into a cell and do all of your charting and ongoing charting as well.  The next LC who works can get into that file and see the history and knows what plan has been followed for each patient.  Now about the shield, I feel we need to match the mom's nipple size with the shield size.  I closely follow those babies whose moms' have large nipples and babies have small mouths.  Eventually the baby has to open wide enough to fit mom's nipple or it won't work.  I have tried to switch to the larger shield sometimes when the baby is quite little and find they draw better from the breast.  A good way to check this is by using the baby weigh scale.  Usually this happens after baby is doing well, is growing but is starting to slow down on weight gain. This is all before discharge. So there is no one right way to do this.  If mom's nipple is large and you use a small shield, baby only really sucks the nipple into the shield and doesn't stimulate the areola for more milk production.  Thus it is important for the mom to keep on pumping after each feeding so her milk supply does not significantly decrease.  This is getting long enough that I will close for now but may be sharing more on this later.  One more comment on shields:  They have had such bad press.  We don't often comment on the baby who is pushed to the point of shutting down at the breast or the mom who is ready to quit, in tears because of the struggle - all so we can avoid that "terrible shield".  It is time for us to get rid of that old thinking and work responsibly with each patient.  I have an active phone follow-up program with babies going home on shields.  Many also come back for visits to check weights and see if baby is ready to try without the shield.  My experience has been very positive and I hope we hear from others out there as well.

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