I am really concerned about all these moms who are given nipple shields and
not able to get off of them.  It looks like the "indication" for use of a
nipple shield has changed from supposedly helping with sore nipples, to
helping with latch problems.  It is not a good sign, when the indication for
an intervention changes, especially without an interruption in the use of
it.  What you end up with is the intervention having come before the
indication!

My experience with nipple shields is different than most, so I thought
perhaps I could suggest something that might help with these babies who get
stuck on a shield and can't get off.  These things are probably more likely
to help with a baby who is a few months old, but may help with a younger
baby too.

There can be more than one reason the baby is not willing to try latch right
onto the breast, without the shield.  I used a nipple shield as a step in
getting my daughter, Julia, whom I adopted at six months old, nursing, and
have since been in contact with several other adoptive moms who have used a
nipple shield as one step in taking an older baby from bottle to breast.
Prior to using the nipple shield, I had fed her with a wide-based bottle
nipple which had a SNS tube threaded through it, so that when she sucked on
the nipple, she got the milk from the SNS bottle.  The advantage of this was
so that I could get her used to feeding in an exact position as for nursing.
  Once she was comfortable with that position, I tried moving the bottle
nipple, once she was settled in and still sucking, half asleep.  She would
open her mouth and search for a nipple but, when I tried to get her to take
my breast, she would close her mouth as soon as her tongue touched my skin.
What helped was an Ameda-Egnell latex nipple shield, which was a very thin
shield that did not have a firm "bulb" on it like the brand new (at that
time) Medela silicone shields.  It tasted like the bottle nipple, but
comformed more to the shape of my breast.  After using it for a few days, I
moved it one day and she finally latched onto my breast.

Another adoptive mom with an older baby used a nipple shield, which she cut
down to expose ever more breast.  She started cutting from the outer edge of
the shield, not the tip, until the last piece was where his tongue touched
the breast (I believe she hung onto it at this point to make sure he
couldn't swallow it).  Now, this was a latex shield, too.  I have heard some
suggestions for cutting down a silicone shield, but I have never been able
to do it without leaving a noticably sharp edge.

I know that most of these moms now are using silicone shields, so these
exact measures might not work as well, but I am offering them as examples
that may help someome come up with ideas.

Here are a few additional suggestions:

Try to move the shield after the baby is pretty much fed, half asleep, and
contentedly sucking.  Many babies will open their mouths and search, without
opening their eyes, which can provide an opportunity to get the breast in
there.  (Another advantage of trying to move the shield in the middle of a
nursing session is that the nipple may be standing out a bit more than it
otherwise would).  If the baby takes the breast when half asleep, he may
take it next time, while awake, or it may take a few times making the change
in the middle of a nursing session.

Do not try to make a change in feeding experience when the baby is hungry or
otherwise agitated.  Pick a calm time to try.  If the baby starts to get
upset, give him what he wants and then try again later.  In general, with
older adopted babies, we have found it best to wait a day or more before
trying again, if the baby has gotten upset with a change attempt.

Take the attitude that the baby wants the bare breast, but just doesn't know
it yet, rather than that the baby just plain doesn't want the breast without
the shield.  The baby has been confused into thinking that a nipple shield
is "supposed" to be there.  Even many of our older adopted babies who have
had very negative responses to the breast, at first, have learned to love
the bare breast, and even gone on to nurse for extended periods. (However,
negative experiences are best avoided where possible!)

Have the mother rinse her nipple and areola prior to doing this, to get off
any salt or other substance that might flavor her skin and disturb the baby.
  I do not know if the flavor factor figures in with alot of babies or not,
but it does with some, so this is worth a try.

Bottom line, hang in there and keep trying, but don't feel like the change
has to take place immediately.  A sense of urgency will only work against
both mother and baby.  Use patience and creativity.  Emphasize the
advantages of making the change (greater ease in nursing, better milk
supply, etc.), so mother sees that it will be worth the effort.

Perhaps telling the mother about adoptive moms' experiences might help, on
occasion. We have an advantage in that we expect nursing our babies to be
challenging, and have also usually developed a pioneering spirit, in our
quest to become mothers.  This should not be related in a way that
trivializes the bio mom's challenge, but which emphasizes the idea that, if
there is a will, there is a way!

Aloha,
Darillyn



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