In a message dated 2/20/0 8:06:30 AM, [log in to unmask] writes:

<< while struggling with rapidly declining milk supply.  Most recently, a
mother had to turn to a hospital-grade breast-pump >>

pump use should begin if/when shield is introduced so that milk supply is
encourged and optimized. pumping pc/shield would be one routine management
strategy to increase/maintain supply while working toward fdg @ breast.  alt
fdg method of choice to supp ebm to baby.

(pc/=after feeding with. ebm=expressed breastmilk)

Barb ask:<<My question, for those who work in hospitals:  Where are nipple
shields
kept and who has access to them?>>

locked up in the lc office/lcs

Susan wrote:<<I've never seen a baby effectively extract colostrum through a
shield.>>

good point

<< If I were to start a shield at this stage...I'd be very concerned about
the baby's
hydration and the mom's supply. If I am going to use a shield anyway....why
not
use a bottle>.

i agree with your concerns.  for the mom with a nipple/areolar complex
variation that defies latch in spite of all the usual
remedies/tricks/interventions, while continuing to work toward latch during
the first 48-72 hours postpartum, sometimes bottle is the way to go. depends
on many variables.

but, one response to your question would be: with shield use, baby provides
some stimulation, and at some point may be able to pull nipple out to inside
tip of shield
--> increasing nipple protractility and areolar elasticity. a pump may do the
same, better or not as well. in regards to the process of baby using shield
to pull the nipple out tho, there probably should be a concern about excess
energy expenditure with some babies/non-nutrative sucking.

also, some moms are encouraged by the semi breastfeeding. an alternative to
bottle fdg would be that supplements can be given with a 5 fr feeding tube or
sns @ shield.

Debbie

Deborah Tobin
RN BSN IBCLC LCCE
Springfield, Virginia USA
In the suburbs outside the Washington DC beltway

             ***********************************************
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