Elise,
I have used the periodontal syringe prenatally to draw-out inverted nipples,
then optimally assisted with latch shortly after birth using an asymmetrical
latch, and encouraging lots of skin-to-skin holding during the 1st 24 hours in
the event of a sleepy baby from a medicated birth.  When moms experience sore
nipples due to the nipple crevice inverting after feeds and remaining moist, I
have used the nipple ring from the Lactation Institute to maintain the
nipples in eversion long enough to allow for nipple drying and thus healing.  I find
that most moms do not like to wear the shells, finding them uncomfortable,
and not very helpful.  I don't use shields in the early days of life, but may
find them necessary after the first 5 days if mature milk is coming in and my
assistance with latch doesn't result in baby's ability to maintain compression
in order to sustain a latch.  I would rather use a shield at this time to keep
baby at breast than to have a non-breastfeeding baby and a pumping mom.  I
recommend moms pump at least 2-3 times in 24 hours when using a shield in order
to protect the milk supply.  And, when I use a shield, I teach mom how to
properly place the shield onto the nipple to prevent an improperly placed shield
that could result in a shallow latch.  I also properly fit the shield so that
the smallest one that can be safely used is the size chosen. Lastly, when I
start to use a shield, I incorporate ways for mom to wean baby off of the shield.
As a result, most moms with inverted nipples are able to exclusively
breastfeed and to wean their babies off of the shields.  Good-luck with this mom!
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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