Paula Meier said: " The research proves that the shield does not cause a
decrease in milk supply.  You have the research to support this, NOW USE
IT!"

...and I totally agree with her in terms of my experience of evaluating a
mom, helping her use a nipple shield and using it as long as she needed to
... in fact, one of the moms I worked with used it for over EIGHT months -
only nursed on one side, because the other one was pierced and she found
the leaking annoying - then the baby weaned to the breast!

I say this just to clarify that I am NOT terrified of nipple shields and do
use them - in fact quite often, as the moms I see are not "convinced" this
"breastfeeding thing" is "really" going to work - and latching the baby on
with the nipple shield and having them SEE their baby get full and the
shield fill with milk is often a great "sales technique".

HOWEVER, I just did two 2-hour sessions with staff at a local hospital -
and in THIS case I stated unequivocally that if they put a nipple shield on
ANY mom, she should have an automatic referral to a Lactation Clinic,
IBCLC, or our Public Health Nursing (PHN)  staff.  Why?  They often don't
see the baby get good milk transfer (moms are there for less than 48 hours
- often less than 24), they can't observe full feedings (baby gets very
sleepy, mom has interruptions, nurse has 4 other mother-baby pairs to
check, etc.), and are not yet (though I hope they learned a lot from my
training - 2 hours is not enough time to teach EVERYTHING) knowledgeable
enough to evaluate the breastfeeding.

If any of the PHNs I work with or I decide to use a nipple shield, then we
know she needs to be followed until weight gain is appropriate with no need
for supplementation or pumping - whether this is using or NOT using the
nipple shield is not the primary factor.  The need for a nipple shield
indicates there is something to be monitored.

However, I do try to reduce the stress the mom feels if people tell her she
HAS to stop using the nipple shield "quickly".  In fact, I wish Medela
didn't have so many precautionary ("CYA") statements in their instructions
- moms read them and then try to do without the nipple shield, find they
can't - and go to the BOTTLE instead of back to the nipple shield!

I find that moms have been pretty good about weaning to the breast - sooner
or later - as they see that their baby is better able to suck.  Often
they'll keep using the shield on one breast but not on the other - again,
that indicates to me that they are aware that for whatever reason, one
breast/nipple may be more difficult to milk - and they are responding to
this appropriately.

The shield, like all our other pieces of equipment (SNS, Pumps, etc.) are
like crutches - and appropriate use for the necessary length of time can
make or break the breastfeeding relationship.

Jeanette Panchula, BSW, RN, PHN, IBCLC
NEW e-mail address: [log in to unmask]

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

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