Jack Newman writes: <snip>

> You hospital based LC's mustn't forget those of us
>that are faced with a mother of a 7 or 10 day old using a nipple shield.

This has echoes with what happens here (UK). I appreciate that hospital
midwives want to send a mother 'into the world'  breastfeeding rather than
bottle feeding, and yes, it's a judgement call always, based on individual
needs. I find it hard to accept there are many cases where it is wise
before the milk has even come in, though....

What I have learnt is that follow up is *essential* to support the mother
through the (often)  difficult period of weaning the baby off the
shield...and despite our comparatively good home-based after care in the
UK, this is too often lacking.  Nipple shields may well be a useful tool in
the right hands in some tricky situations, but without good follow-up they
are risky.

We (volunteer breastfeeding counsellors) often see mothers at 7 or 10 or
even more days, using a shield, and often having had a fright because they
have discovered their baby is not gaining weight at all, and may even be
continuing to lose weight.

Nipple shields here are one size fits all (or not) and in my experience are
longer than most mothers' nipples. Getting a milk supply established is
really hard - the baby may manage to suck milk through for a few days,
enough to keep things ticking over, but he is not latched on and he is not
stimulating a supply.

Volunteer counsellors are lucky in that we don't only see women with big
problems - often the mothers we're in touch with have no problems at all
and are bf happily, and we are in touch with women across the whole bf
period. Some mothers tell me their use of shields has been a life line to
them. However, I would stick my neck out and say that *most* women who use
a nipple shield do experience ill effects.  This may not be the tool
itself, of course, but the context in which it is used.

Our local maternity unit has an official policy of 'no nipple shields'
(mothers are discharged on day 1-3,  often before the milk comes in) but
mothers still get them....midwives either rustle them up from some hidden
corner or get the fathers to buy them and bring them in.  They do it
secretly - one mother told me her midwife said 'we aren't supposed to give
these out - they're like gold dust'. This same mother then went on to have
*serious* problems with supply, rescued with a lot of hard work and
support.

Heather Neil
NCT bfc Newcastle upon Tyne UK

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