Koren

Welcome out of lurkdom. Good observations and questions on shields.

Just to give some perspective on when shields are really useful. I do not 
have shields at the hospital where I work. There have been only a handful of 
times in about 4 yrs when I felt I could have really used one. In those 
cases I have one as a sample and show/explain to mom and suggest it may help 
and they can purchase one. I can then do an office consult on how to use. 
These cases are usually for inverted nipples. We have decided to order some 
shields (don't have them yet) but only my personal cart will carry them. The 
nurses will not be able to give them out.

These are the things that usually help tremendously and make shields 
unnecessary in most cases:
Initiate breastfeeding w/i 1 hr of birth.
Practice skin to skin care and rooming-in.
Show the mother how to position the baby in cross-cradle, cradle and 
football holds (at least one of these) so baby can access the nipple/areola 
ideally and latch.
Learn and use RPS (reverse pressure softening) which works to evert flat 
nipples, start an MER, and move edema out of the way to make the 
nipple-areolar complex quite latchable in most cases.
Begin expressing colostrum early and spoonfeed to baby if he's not able to 
latch. Often the next day the baby does latch.

I think the nursing staff get very nervous when the baby does not latch and 
grab for a quick fix.
Often the baby has not fed and is not gotten to his mommy for many hours and 
they begin to panic a little. Nurses need more skills at assisting bf moms 
and of course implementation of baby friendly practices. Easier said than 
done.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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