Hi all, just had to share a success with you for a change.  Saw a mom in
hospital four weeks ago, called by husband who was concerned that his
day-old son (second baby) was not "getting enough" during breastfeeding.  On
the way in the nursing staff hissed at me in shocked tones that the mom was
using a nipple shield.  Sure enough, Avent shield, baby was happily latched
and sucking and there was occasional swallowing.  The breasts were fairly
large, and the nipples were normal, not overly protruberant, but certainly
graspable.  Mom was adamant that she wanted to continue using the shield.
History revealed that the first baby had been born prem in New Zealand, had
never latched direct, mom had been advised to use a shield, and continued to
use it for the whole six months that she breastfed this baby.  I reassured
her about the amount of milk she was making and gave info about urine/stool
output so that she could assess that the baby was getting enough in the next
few days.  I also gave info about how to wean off the shield when she felt
ready.

Next contact was today.  Baby was exclusively breastfed, but mom was
thinking about formula because she was still concerned about whether the
baby was getting enough. Weight gain was good, (30g/day since day 3) feeding
interval/duration were normal for a breastfed baby and the baby himself is a
real little bruiser - big, strong, determined, fabulous.  But the wretched
shield was still in evidence.  Mom said she had tried to *not* use it
occasionally, but baby would just become frustrated.  I suggested attempting
to latch without it now so I could see what he was doing.  Got very picky
about the positioning (prem hold, cupping the breast) showed her how to make
a sandwich out of the breast tissue and described the hamburger theory
(thank you Diane!)  Just a couple of tries and the baby was on.  Several
more tries when he kept coming off (she kept letting go of the sandwich!)
and then he was away - lovely large mouthful, wonderful gulping swallows,
excellent milk transfer.  Mom was becoming uncomfortable so she changed
positions (Madonna) and used the scissor hold for the breast and again it
worked.  Then she changed breasts, using scissors again and it worked again.
By now it was so casual no-one was even bothering to enthuse.  Fait accompli.

So just to let you know that it *is* possible to easily wean off a nipple
shield once the baby is breastfeeding well with it, once his intake is
really good and with careful attention to technique.

Pamela Morrison IBCLC, Zimbabwe