Dear Friends,
In this I can fully agree with Susan: it is not the tool that is good or bad. All tools depend on the use it is made of and the user that applies it.
I very well recognise, Susan, your story about teaching about nipple shields and at-breast feeding devices. They, too can be good or wrong depending on the user and the circumstances.
I do see some use for nipple shield, occasionally, and for at-breast feeding divices. As for scales, I haven't had any cases in my practice that made me wish I had a scale at hand. But, as I've said before, I mainly work with moms and babes in at-home situations and I can take the time I need to work with a mom and do proper follow-up.
Warmly greeting,
Gonneke, IBCLC, LLLL
Susan Burger <[log in to unmask]> wrote:
Dear all:
I also want to point out that my training had demonified nipple shields. I was told that they would
always limit intake and milk production. That these were archaic devices that should never be
used except in extremely rare circumstances and I never was taught how to use them because I
was never shown what that circumstance was. I was trained to use the SNS for everything.
It is Lactnet that pushed me to do more reading and overcome my fear of the nipple shield. I
worked with it, figured how how it was helpful and how it was not and now feel confident in its
use. Again, there are general use for its use that I have sometimes violated when the specific case
really seemed to warrant an unorthodox use. At the same time, I started analysing when a tube at
the breast really wasn't helping. I rarely use either tool and I see a lot of misuse of both of these
tools, but I don't demonize the tool.
Now that I think about why these tools are misused - it is usually due to the fact that those who
use them are in settings where they cannot spend a lot of time with any one mother and they have
a limited ability to do follow up. Thus, they do not see the consequences when these tools are not
working. The circumstances of their work settings are very unlikely to change, so it would make
sense to me if some system of referral for follow up should be implemented.
Ditto with scales. In some settings, it may be much more appropriate to refer difficult cases where
a scale might be appropriate to someone who can do the regular follow in a manner that won't
stress out mom and where the scale can be used as a teaching tool to get mother to trust her own
observations by someone who can do the longer sessions and regular follow up.
Best regards, Susan Burger
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