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Date: | Wed, 5 Apr 2006 18:42:56 EDT |
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I keep in touch with mothers who have left the hospital using nipple
shields. I've only had a few mothers who did not bring in a full supply while using
a nipple shield. And that is without using a pump.
One right now I'm watching and will see tomorrow one mother and baby because
the baby had lost 10% at the first check-up after leaving (usually 4 to 5
days old.) I wondered if the baby had Down Syndrome when I saw it on day 1.
After discharge a conversation I had with the staff nurse revealed she wondered
the same thing. I assumed the baby's doc would pick up on it if it was.
Mother does have a pump and is pumping to establish good supply.
The work of Paula Meier has shown that premature infants often do better on
the breast with a shield which allows them to conserve energy. That said,
mother vary widely on the consistency and volume of colostrum. Once after we
expressed one large drop of colostrum (and no more) the mother was bringing
the baby in to transfer it to the baby's lips or tongue, it stuck to the lip
and had already jelled into a solid drop! I was astonished. Another mother
was able to pump an ounce and a half from each breast on Day 1. It's rare to
see that much for many mothers on Day 2. Often pumping rather than hand
expression results in drops of colostrum all over the inner surface of the shield
flange and tunnel and if any makes it the sides of the bottle. These drops
don't often coalesce and are hard to collect. We do try to with a dropper.
If we do encourage a mother to pump it is for the stimulation to increase
hormone levels when a baby is not opening his mouth and there has been no latch.
Once mother who not only had a c-section birth, but had to go back to the OR
to remove a clot was not able to get her baby latched. I did help the baby
get on to a very large soft breast without a shield, but this baby kept
losing his grasp. This was with a good off-center latch with that baby's mouth
wide, and the breast supported so the weight of it wasn't pulling it from the
baby's mouth. We tried hand expressing colostrum but got only the tiniest
glistening drop. Introducing the shield (at 14 hrs of age) really helped him
settle and suckle for a good twenty minutes. I heard some swallowing only after
five minutes at the breast. I believe that the stretch of the nipple is an
important source afferent nerve impulses from the breast to the brain and can
effectively raise prolactin and oxytocin levels. The baby was then able with a
lot of work during the night (good nurse on duty) to achieve latch without
the shield. I usually never use a shield on the first day of life. This was
an exception.
Another one is if the baby has a very hard tongue thrust which continues not
matter how well the baby is positioned and latched. And the mother already
has a cracked or blistered nipple. (I've noticed that if you watch babies on
the first or second day of life and see them playing with their tongues,
poking them out, holding the tip of the tongue between their lips and sucking, all
habits acquired before birth, that these are the babies who suddenly lurch
off of the breast, or back off to latch more shallowly during a feeding. Some
of these sustain a decent rhythmic suck and when relatched good tongue
movement for a time; others cause friction and nipple abrasion.) We use a shield to
protect the mother and allow the baby to nurse in her arms. Often when
copious milk appears, the baby is able to start to sustain a better tongue
movement during the steady suck-swallow - breath bursts of suck and the shield use
is discontinued, but not always.
Mardrey Swenson, IBCLC
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