Re:  the mom in Alaska who lost her milk supply while using a shield.  It
may or may not have been the fault of the shield.  Often, babies who have
dysfunctional sucks or are too weak or small to stimulate a milk supply will
continue to take the breast with (but not without) a nipple shield.  IF the
shield is the right size, IF the baby is well-latched, and IF the mother
doesn't have some sort of primary or secondary milk supply problem, a shield
using baby can grow well and adequately stimulate the milk supply.  All bets
are off if the shield is too big, or the baby too weak to stimulate, or if a
bad latch works against everything.

The time to intervene and manage a faltering lactation is very early on.  By
12 weeks postpartum, the milk supply that has never been appropriately
stimulated has probably down-regulated.  Mike Woolridge calls this "an
acquired low milk supply." He claims it typically is difficult to
re-stimulate it past 6 weeks, although I'd probably throw some domperidone
and super-pumping into the mix just to see.

A better bet is for all concerned to recognize that a baby who can't
breastfeed without a shield is, by definition, a baby in trouble.  Someone
needs to closely assess why the baby can't feed and monitor the
interventions (like the shield) to make sure they are working.  Often, the
milk supply needs some extra protection the baby can't provide.  Shields can
work well as an intervention, but they should be used purposefully and with
some on-going supervision (if nothing more than a ph. call every so often to
see what is going on.)

A mother with one experience of lactation failure is at high risk for a
second failure and needs monitoring.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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