Hi Michelle,
Congrats on your new role as LC. It sounds like you certainly do wear many
hats and that can be a challenge for co-workers to accept the changes you
are going to try to effect. I also work in a small rural hospital
(Mississippi). The culture in the community and in the hospital will often
be very different from that of a nearby big city. First I will suggest (34
yrs experience) to observe first what is going on and try to wait just a
little to make a change. In other words, tackle one thing at a time, but
first gather info and just ask and observe. This will be very very hard to
do. (I'm still working on this!).
In regards to nipple shield use, I have learned over the years to accept
and use shields a bit more than I did in early years. Still not very often
and I definitely don't agree that every mom that was given a shield needed
one. Often I see moms coming in with a shield packed in their suitcase when
they arrive in labor, because they heard or their sister needed one and
they had it at the ready.
I would sort of ask the nurses and the mom, non-threateningly, what sort of
problems led to the shield being used, and did it help, did the mom get
taught the correct way to use and clean etc.
The manufacturers of the shields often have a handout. I use the Medela
shields at work and use their handout. I emphasize to the nurses that they
need to be familiar with the handout, that they are responsible to instruct
the mom on proper application and use, cleaning, expressing their breasts
after each feeding, and need for followup. The mom should then be given a
copy of the handout. I advise that it is a liability if the baby does
poorly (wt loss, hosp re-admission for jaundice) and the mom was not
properly instructed and document same, it could come back on the nurse
legally.
Getting back to observations, try to address the issues the nurses used the
shield for, instead of just trying to stop the shield use. You are doing
the same thing, but coming at it from a different angle. For example, the
mother had flat nipples. Are you familiar with RPS. That is a great thing
to teach nurses to teach moms, it often works wonders on edematous
nipple/areola and then a shield is not needed. Or to use RPS before
expressing to get more milk out. Sometimes I try to remember that the nurse
offered the shield instead of the bottle, that is a positive thing. Often
the nurse sees the mother is about to give up, and go for the bottle, so
the nurse sees the shield as the "lesser of 2 evils." I also love teaching
hand expression and spoon feeding, along with STS, and our nurses are now
so much more comfortable with this than they were a couple years ago. Just
seeing that moms can get milk out and babies don't need much beyond small
servings of colostrum and STS the first day. So you could approach it this
way (ignoring shield use for the moment): "I have learned about RPS and it
works wonders! It is great as a first line intervention for moms with flat
nipples! Here's how to teach moms to do it."
Sorry this post is getting too long, I hope I am making some sense and you
will glean some benefit. Warm regards, Laurie
Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA
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