>    Every time a nipple shield is given, is it "automatic" and our
>standard of care that the mother must also be using an electric pump?
>Does it depend on the mother?  If she is 4 days post op and milk has come
>in and is visible in the shield while baby is feeding, is pumping still
>necessary?  We are trying to write a policy on nipple shield use soon.
>   I know of a mom or two, who when given a shield and electric pump at
>the same time, said she would just bottle feed then, as it seemed
>overwhelming to her.  Any comments on this?  Thanks.
>     Susan Potts  rn ibclc
>     Minnesota

Susan, I don't work in a hospital, so my views on the use of nipple
shields may be a bit different to those who are working with
newborns, but I rarely advise expressing when nipple shields are
used. It depends on the reason for the nipple shield. I nearly only
ever use them when baby is unable to attach because he needs palate
stimulation to get his suck reflex going, such as with flat or
inverted nipples. Never for 'sore nipples'.

My feeling and observation are that, if the nipple shield is being
used *appropriately* (ie baby is correctly attached to the breast,
compressing sinuses, etc and not just 'hanging on the end') then baby
will be efficiently draining the breast as if the shield wasn't
there. If baby is not attached and feeding in this way, then the
nipple shield should not be used!

I think many people have got so paranoid about 'lack of stimulation
to the nipple' with shields that weren't being used properly, that
they assume that the mother *must* express to maintain her supply. I
think this just illustrates how *badly* shields have been used. It
used to be thought that direct contact of baby's mouth and nipple was
necessary 'stimulation' for the nerves in the nipple, etc to maintain
supply. We now know that the stimulation is *removal of the milk*
(autocrine control of supply) so that as long as that is happening,
it doesn't matter if there is a layer of plastic in between mouth and
breast. Of course, if this is not happening efficiently with baby
alone, then expressing can be a good 'extra' for milk removal.
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Nursing Mothers' Association of Australia Breastfeeding Counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

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