Someone posted to me privately about whether I use a consent form when I
hand a mother a nipple shield.  Here is my reply to her:

I don't use consent forms beyond the intake form that each client signs.  I
am cautious to not select a treatment modality that I feel would harm
someone.  I monitor outcomes to make sure.  PROPERLY USED, shields have no
unacceptable risk levels that I can ascertain. I consider it vital that the
following components be in place:

         - accurate assessment and appropriate treatment selection
          - correct size selection
          -  proper latch taught with return demonstration
          -  postfeed pumping until supply is adequately documented
          -  cleansing instructions (article on cleansing dental acrylics to
prevent candida suggests
                Listerine soaks for 1/2 hr)
          -  weight checks provided
           - follow-up in the community (pedi notified that baby has gone
home with shield and needs monitoring)

Do you have moms sign a consent for pumping?  Improper use of pumps (poor
flange size selection, incorrect assembly, too-high pressure, over- or
under-pumping) can create lactation failure.  If you spelled out all those
risks on a consent form, it would make women scared about pumping too.

These tools are the tools of our trade, and if we understand how they work
and use them correctly, they are unlikely to do harm.  I think the ones who
ought to be made to sign consent forms is the STAFF.  Each ought to be
properly and thoroughly in-serviced on the use of lactation tools, and the
supervisors ought to have to sign off each person authorized to provide
lactation assistance only AFTER they demonstrate competancy using these
tools.  I'm still seeing women who have been given huge shields -- much
larger than the baby's mouth can accommodate.  I still see terribly latched
babies.  Women given shields are then immed. told how dangerous they are.
The women come home so distressed to be using shields that they go to
pumping and bottle feeding because they are so convinced nursing with a
shield is bad.

 Nursing with a shield is not NORMAL.  You wouldn't use a shield if you had
a normal situation.  But it's a bridging tool in the NOT-normal situation
that is dandy for fixing SOME problems.

I'd like to see more people lecturing and writing on the finessed use of
tools.


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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