<Our UK correspondents give these descriptions: "the nipple on
>the shield is *Enormous*, a super stimulus, which then lets everyone
down
>because the top end is never filled by the mother's nipple, the nipple
fills
>the baby's mouth because it also has a wide base so all baby can do is
nipple
>suck" and " you see these great big things on mother's nipples that seem
half the size of the baby's head.....and the material used in the shield
is
very inflexible and thick at the point it 'turns the corner' to become
the
base>

This description fits a type that was very common in the US 20 + years
ago.

It actually seems to be 1/2 breast pump and 1/2 bottle in its effect.

It's really not so bad in regard to the mother's tissues. The firm part
is shaped similarly to the bell or flange of a breast pump, only the
vacuum force is GENTLY provided by the baby. (Versus some breast pumps or
a very vigorous improper latch, which can damage the tissue.)

If the areola is SOFT ENOUGH, the nipple can be drawn far enough into the
contraption for the milk reservoirs to milk themselves against the
"bend". Evidence of some milk transfer can be seen with the naked eye, as
it pools in the front space of the plastic part.

Whether this gives the nipple and the nerves deep within the areola
enough stimulation long term, I cannot say. But it can be fairly
effective in gentle milk removal if the areola is soft and the mother has
had an MER stimulated (perhaps manually).

As far as the baby goes, the rubber nipple seems in many ways to have a
worse effect than a bottle. Two "positive (?)" aspects might be the fact
that the milk is delivered into the rubber nipple more slowly, therefore
neither choking the baby nor giving instant gratification without effort.


But negative aspects are that the baby has to exhaust as much of the air
between mom and within the rubber nipple as possible, and keep it
exhausted. (Any rest period means starting all over, and more air
swallowed.) The baby has to work its oral muscles very hard, much harder
than with a bottle, to produce enough vacuum to milk the areola even
gently.

This work takes place without the proper physiological application of
direct mechanical leverage of the jaws or tongue to the breast. I would
guess that the extreme difference between this and the natural suckling
process confuses the baby as much or more than a bottle.

Rule #1. Feed the baby. If nothing else is available, it can be a useful
crutch, a "bridge to breastmilk" during a short period of difficulty. But
a physiologic,  long term solution it's not. How difficult and costly
would it be to import a more physiological type of shield? Reps, can you
come up with a plan if there is interest in this?

As Pamela Morrison says,
<Just as there are pumps and pumps, so there are shields and shields.  To
condemn them all is to miss out on a wonderful last-resort tool which can
allow breastfeeding to take place in a seemingly impossible situation.>

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio

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