I am surprised to hear that other consultants have had successful
experiences with nipple shields.
   I do agree with one comment that  they should be "under lock and key". I
would hate to go back to the days when they were used first for attachment
problem or on the store shelf. There is one specialty shop in town that
suggests that ever mother get one prenatally to cope with the soreness "you
know you will have".
   I also wanted to qualify my original comment on mothers having poor
positioning etc skills after 24 hour discharge. I DO NOT think this is the
fault of nursing staff or unninformed parents- I feel that some mothers are
just "klutzy" to steal someones description. Some kids can ride a bike first
time on others you have to run with for weeks. It took me a month to get my
baby's diapers on right consistantly - you can imagine how bf was going!
    To the question about trimming the shields- I do not recommend this
method because in addition to sharp edges, I think it is possible for pieces
to break off and be swallowed. I don't think two days of use is excessive-
they are probably still getting the techniques down. I don't feel comfortable
after 1 week and would continue close weight and output monitoring the entire
time a shield is in use. I have had very few mothers continue for longer than
two weeks but their babies were thriving.
      Expressing after each feeding is a real inconvience to mothers who
finally feel like their baby is nursing but I am so cautious after seeing
babies compromised and supplies disappear  before the mothers came to me "in
the old days" prior to the thin silicone shields. This is probably is why I
have not seen milk supply as a problem. Giving the baby extra expressed milk
by whatever method of feeding the mother had been using while they are
learning  new skills seems to keep them more relaxed, better able to
concentrate.
      Another consideration about delayed latching on that seems to help
mothers is the changes in breast and nipple tissue during the first month. I
think if mothers understand that engorgement and normal fullness will
continue to diminish and nipple shape changes in the first few weeks so the
initial problem may simply disappear. As long as supply is up and other
techniques improving there is hope.
        A New Question? I have adoptive mothers in my practice fairly often.
I am familiar with all the drug therapy/ pumping protocal presented  at ILCA
in 93 in addition to herbal type induction or just nursing with a
supplimenter. I would like to hear others share what has worked or not to
build supply. Do others feel that JUST nursing is less stressful or is it
worth trying all the tricks to get supply up?  I want mothers to enjoy
nursing but they seem to focus on supply, any suggestions?
               Debby Kearney IBCLC Glad to have a new reason NOT to watch
Barney!!!!!