I truly appreciate all of the discussion regarding nipple shields!! Being a hospital-based IBCLC, I am frequently faced with questions from nursing staff regarding conflicting recommendations for pumping. In our hospital, nipple shields are available to staff nurses to dispense to patients when needed, often without an IBCLC consultation/followup. Our LC staff feels that if the staff RNs are prevented from dispensing shields, then many more mothers may quit breastfeeding since we do not offer 24 hr/day IBCLC coverage/support for pts.
Question: how are nipple shields dispensed in your practice sites? Can any staff member supply a shield or must the pt be evaluated by an IBCLC, etc…?
Also, regarding liability, how does an IBCLC justify pumping recommendations that may not match the manufacturer’s guidelines??
Thank you,
Amy
Amy Wagner, BS, RN, CCES, IBCLC
Hershey PA
> On Oct 18, 2016, at 1:10 PM, Jeanette Panchula <[log in to unmask]> wrote:
>
> Thank you all for the great comments made about pumping and nipple shield
> use. I continue to learn and also re-learn from Lactnet as I have for many
> years!
>
>
>
> I would like to reiterate what was said in some of the replies - and that
> is: "It depends" when it comes to the use of pumping after using the nipple
> shield.
>
>
>
> Frankly, right after birth, if the nipple shield is used, I see no use to
> pumping, as the colostrum does not flow well with most pumps. I would
> encourage hand expression. This is easiest to learn at this time, before
> the breasts are hard and swollen, and she is more likely to be able to learn
> "kinesthetically" as she is using her own hand and feels it with her own
> breast. This is more effective than trying to teach how to assemble a piece
> of equipment (I used to teach dads and grandparents) and how to use and
> clean it.
>
>
>
> The concept that we can assess "good milk transfer" with the shield while in
> the hospital I find unlikely, as the swallows heard and even the test
> weighing may be suspect, unless mom and baby are in the hospital longer than
> the usual (in my area) 24 - 36 hours.
>
>
>
> Perhaps there could be a way to communicate with moms after discharge by
> sending an e-mail with links to websites that show how to assemble and use
> that particular pump with instructions to start this pumping when they see
> their milk is flowing better? Just trying to think "outside the box" -
> literally!
>
>
>
> What I am observing in my area is the lack of early EFFECTIVE follow-up -
> yes, they see the baby, yes, they weigh the baby, NO ONE observes a
> breastfeeding (how can you with appointments that are scheduled and may
> likely not coincide with baby's desire to nurse, or with a hysterical baby
> who cannot be calmed in the 15-minute slot they are given?). What is worse,
> there is not another appointment for 2 weeks (if she's lucky) or longer!
>
>
>
> SOOO - my answer to your question about having moms use breast pumps when
> initially using nipple shields is: "it depends" on your own areas' follow-up
> system and the mom's ability to get to them. (We also have no good
> transportation!) A great topic for a community breastfeeding coalition
> discussion, as well as one within your own hospital staff and staff that
> receive your babies for postpartum and pediatric care.
>
>
>
> By the way, do you have moms calling saying the box said to not use the
> nipple shield for more than 3 days.so they threw it away and now want to
> know where to buy another one? Getting that a few of those lately! Great
> marketing plan! (Of course I would love to have a mom evaluated and
> encouraged to stop using the shield, but it has to be after observing that
> whatever caused the initial indication to use one has now been addressed!
>
>
>
> Jeanette Panchula, LLLLeader, RN, PHN, IBCLC
>
> Vacaville, CA
>
>
>
>
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