LuAnn Smith asks for input about a study on nipple shields and infant growth in the first month of life. I assume you would recruit mothers who are already using shields (whether for a selected group of indications or all indications) and then divide them into two groups: 'advised to pump routinely 3-4 X daily and give hindmilk' as per your post, and 'not advised to pump routinely etc', or perhaps 'advised to pump only if they perceived their breasts to have been poorly drained', and then follow them closely for the entire month. I think it could be defended ethically. By closely, I mean twice a week, with recording of accurate weights for the babies, and recording of all feeding sessions, wet diapers and stools and pumping sessions for the entire month. If any mothers stopped breastfeeding or stopped using shields during this time, for whatever reason, it would need to be recorded too. All episodes of breast problems, like mastitis and soreness, should be recorded. Maybe these regimens influence the continued need for shield use in one direction or another, and that should be determined. I also assume you would be trying to wean the babies off the shields at every contact. It would be unethical to keep babies on shields for the sake of seeing what happens. But trying to find out the safest way of using shields until they can be discontinued, is an admirable goal. If there are differences in the rate of successful weaning from shields, or in the time frame for when it happens, between the groups, that would really be worth knowing. Obviously, if a baby in one group or another is not thriving, you would need to alter the advice given to the mother about how to ensure adequate intake. All such events would be recorded and accounted for in your data analysis. It would be vital to know whether poor gain occurs more often in one group than the other. The mothers would need to keep a log of how often they pumped, in both groups. Note that dividing them into groups doesn't mean that they are bound by oath to comply with the planned treatment regimen. But when you analyze the results, you have to analyze them by 'intent to treat', and not by whether or not they pumped. The mothers are divided into groups at the outset. They can not change from one group to the other, based on compliance. This way, you would learn whether 'preventive' pumping helped maintain supply better than pumping as needed, as determined by maternal perception or by weight gain in the baby. You could learn how acceptable the advice was to your research subjects. And with twice a week contacts you don't risk compromising BF or infant growth. We really need this knowledge. Hope you can carry out the study. Rachel Myr not the most gung-ho shield fan in Kristiansand, Norway *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html