"there are no rules" (M. Woolwich)

I think what was meant here was Woolridge, Michael; and whether it was he
or Chloe Fisher who said about infant feeding that "the only rule is that
there are no rules", or whether Chloe was quoting a 1900's favourite
author, I am not sure. But Woolridge is not a proponent of the Woolwich
nipple shells, named after the famous UK maternity hospital where they were
developed.

And truisms are always both true and false. Write your rules generally
enough and carefully enough and you can have rules: such as the rule that
there are none. Try to make them universal and you are doomed to failure.
When I first began teaching practising healthworkers rather than university
students, I have to say that I was amazed at the desire people had, not to
understand in depth and so be free think out a logical individualapproach,
but to be told do it like this 1-2-3-4 because I am the expert and you can
trust me to be getting it right. It raised real concerns for me about
professionalism, about the quality of nursing and medical education, and
much more. Now things have improved somewhat, but in some places the
tyranny of the RCT is taking the place of the dictatorship of the expert
instructor who was to be believed and followed. Too many people are not
aware that there are many kinds of scientific investigation, knowledge, and
understanding; that an RCT is only as useful as the assumptions underlying
it and the extreme care taken with it; that even if impeccable it is a very
limited truth that is established. No real quality epidemiologist has
problems with understanding the variety of knowledge and ways to knowledge,
but some simplistic medical readers do. At times I despair of us being able
to integrate all aspects of knowledge, from clinical experience to
statistical data to underlying physiology. But we have to keep trying.
However, we have to remember the imperfection of our knowledge, and make
allowances for other approaches and skills. This is very germane to what is
being said about nipple shields. When in doubt about any course of action,
I try to understand more deeply the basic lactational mechanisms and think
about how this action might have an impact on those. I agree with the
person who found Akre's Infant Feeding: the Physiological Basis most
useful; but now of course I end up talking to physiologists. Find one and
educate him/her about human lactation, and you have a great resource. First
thing to say about impact of shields would be that the effect will vary
with the shield and the size/shape of the object to go into it, just as
size 5 shoes work beautifully for some size 5 feet and have a wide range of
problems for feet of other sizes and shapes...If nipple shields are to be
recommended, we need a great deal more knowledge than we now have about
selection, use, and outcomes. On first principles, they seem likely to have
the potential for harm. People are hardly likely to write up the negative
outcomes: I gave all mothers a shield to take home and next week 80% had
weaned is unlikely to make it into JHL, I think. (Well, the person who
submits would deserve a bravery medal.)  Where they're given as the last
tool of a committed LC, it may be the commitment that keeps the mother
feeding and not the shield...
Maureen.