>We are working on policies and protocols for nipple shields in our hospital.

This is actually part of what got me to thinking about protocols.  A nearby
hospital is considering a nipple shield policy (beyond its current one,
which doesn't allow for their use).  Their only IBCLC, a semi-retired nurse
who is called in a few times a month (they have around 1,000 deliveries a
year), asked me for input and possibly for an in-service.

My first horrified thought was that the nurses there need an in-service on
positioning before they even *think* about nipple shields, and my first
comment to the IBCLC was that if I did an in-service on nipple shields I
would have to begin it with some basic positioning information.

Then I thought further.  "You know," I told her, "Nipple shields are
Breastfeeding 301.  The hospital is trying to find a way for nurses who've
had Breastfeeding 101 to use them properly.  It can't be done.  What they
really need to do is just have a policy that only an IBCLC can provide a
mother with a nipple shield.  If a nurse feels one is necessary, she calls
in the IBCLC, who makes an assessment, gets the mother started with one
where appropriate, and arranges for good follow-up.  Then there doesn't have
to be a protocol at all.  They can just rely on her judgment."

"But they won't be able to do it that way because I'm the only IBCLC they
have!" she said.

"That's right, but that's the only responsible way to do it.  They don't
need a nipple shield protocol, do they?  They need more IBCLC coverage."

And it was after that that I got to thinking that only someone who thinks
breastfeeding is simple believes that it can be reduced to a protocol.
--
Diane Wiessinger, MS, IBCLC  Ithaca, NY
www.wiessinger.baka.com

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