Starting in 1952, I had many years of experience with these shields. In
fact, back then there wasn't much else, (except the "bicycle horn" pump
and the thick rubber shield with the heavy criss-cross internal ridges,
which wasn't much better, or maybe worse!). The glass part was one
component of the combination I used in my article on vacuum preparation
of inverted and retracting nipples in 1976.
I always emphasize that suction doesn't pull on milk! IT PULLS ON
FLESH! And the flesh of the areola, if elastic enough, enters the vacuum,
causing the milk reservoirs to milk themselves against the firm part of
the bell of the pump. When you get right down to it, the shape of the
old glass shield is very much like the shape of the bell of many modern
day breast pumps. So I don't think it was NECCESSARILY traumatic to the
mother, because it relied on pure baby power to make it work. (Putting a
pump on a firm areola on maximum strength can be much more traumatic to
the milk reservoirs themselves!) My observations make me think that the
problems with the shields stemmed from two things:
1) The length of the rubber nipple was actually a little longer (though
a little thinner) than the rubber nipples we see on many bottles today.
(It resembled more the flangeless nipple used on REALLY ANTIQUE (50
years or more ago) bottles (I have a few just plain bottles and a few
"bicycle horn" pumps to donate, if anyone is collecting things of this
nature) or almost like nipples used to feed livestock young. This
required the baby to suck out most of the air before the flesh began to
move forward into the vacuum. Needless to say, if the mother accidentally
tilted the shield, the nipple "uncollapsed" and the baby had to start
sucking air out all over again!
2) If the areola was firm and resistant, there was little or no chance of
the baby's being able to pull the milk reservoirs very firmly against the
inner ridge of the shield, and seldom more than a teaspoonful at the most
was obtained. It was my experience that in those days of twilight sleep,
general anesthetics, late starts, supplemental bottles, 4 hour schedules
etc., etc., severe engorgement was almost universal by the 3rd or 4th
day, and most moms stayed 3-5 days, or 7-10 for C.S. But if the baby got
little of no milk from the breast, neither was the suction strong enough
to pull the scab off nor cause any direct trauma to the nipple.
Eventually, the engorgement resolved and the nipple healed at about the
same time. If the mother was lucky enough to still have a milk supply and
keep on trying, eventually, the breast softened enough to allow the milk
reservoirs to compress themselves against the ridge, and milk would then
have some chance of flowing, especially if she had an MER. (Which no one
had even heard of in the U.S. at the time!)
The application which I'd like to strongly inject into this discussion is
that WITH OR WITHOUT A NIPPLE SHIELD OF ANY KIND, latching (or pumping)
is more likely to be successful when the subareolar tissue, deep under
the areola and behind the nipple, is reasonably soft and elastic. If it
is so firm that it exceeds the combined power of compression and suction
that the baby can generate, the mother's nippleareolar complex cannot
properly synchronize with the various components of the baby's oral
cavity.
To this end, I respectfully suggest that one minute of gentle reverse
pressure softening on the areola, followed by manual extraction of 5-6
drops beforehand may be one of the most helpful maneuvers, not only to
soften the flesh, but to trigger the MER in advance of the latch (or
pumping).
K. Jean Cotterman RNC,IBCLC
Dayton, Ohio
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