I think that Natalie is right on with her post on the use of nipple shields in the first 1-3 days. I think most of us who have been practicing for 10 or more years have experienced the paranoia associated long ago with the use of nipple shields. Now we do have fabulous literature from B. Wilson Clay and Paula Meier showing that they do have a place. I look at the use of nipple shields so much differently - they can be a fantastic tool for a mother who would otherwise give up breastfeeding very soon into the experience.

We have great success with our moms who are taught how to use the shield in-house before discharge. If their milk is not in, and there is no transfer of colostrum (which is usually but not always the case), we have them pump and finger or bottle feed until the milk is in. I personally encourage moms to pump after every feeding for about the first week, then encourage a test weight to see if milk transfer is sufficient enough to stop pumping.

In my facility we are lucky to have 7-day coverage, so if the wrong shield is given out to a mom, or she is using it incorrectly, we can "fix" these issues prior to discharge. All of our moms who go home with shields know the importance of followup weight checks and how to contact the LCs if necessary. 

As long as we are on the topic, I have a question - why does Medela have only the largest nipple shield size available over the counter to moms?? What a crying shame. I have had quite a few moms bring in these shields, purchased at Target, and I just can't figure out what the company is thinking. It's a setup for breastfeeding failure.

Brenda Phipps, BS, IBCLC
Flagstaff, AZ (it's snowing!!)

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