I just want to say a few words about nipple shields.  There has come a great
acceptance of nipple shields since the JHL articles last year (?).  I wrote
a letter to the editor about this, saying we must be careful about the use
of nipple shields, that I did not agree with their use early (in the first
few days) as was mentioned in some of the articles, and that only those
experienced with lactation management should be suggesting their use and
then only as a last resort.  I got slammed for that, and I see very often
suggestions for nipple shields on Lactnet.

The cows are coming home to roost...  Whatever.  This week I saw two mothers
with sore nipples who were given nipple shields by public health nurses.  In
neither case did the shield help, in fact the soreness got worse, but this
"solution" prevented the mothers from getting help earlier.  In one case,
the mother, with a ton of milk, had a baby losing weight.  Furthermore,
there are a number of so called breastfeeding clinics (hospital based) in
Toronto area where mothers are being given nipple shields for babies not
latching on, almost without attempts to get the babies on the breast without
them.  I often see the baby on discharge from hospital, and get the baby on,
which I am sure 90% of you could also do.

I am not suggesting that anyone on Lactnet would use nipple shields in the
above situations.  But this is the result of taking a relaxed attitude to
nipple shield use.  It's like using any tool.  Those that know their job use
the tool for what it's supposed to be used for.  Those that don't use it
because they don't know what to do.

Jack Newman, MD, FRCPC