At the hospital I just retired from, this was the experience.
Originally, only LCs could give a shield to a mom.  However, since
we weren't there 24/7, nurses on off shifts, would improvise which
either meant using a bottle nipple over mom's nipple or just gave a
bottle.  We developed a Policy/Procedure which indicated they were
to be used only after a thorough assessment and that they are not
appropriate to "solve" sore nipples.  If an LC in in house, the
nurse was to refer the situation to her to decide if a shield would
be offered.  If it was given to a mom when the LC isn't there, the
RN was to leave a message for the LC indicating when the shield was
offered, reasons, and response.  Then the LC would see the mom to
evaluate further use and to plan for follow-up.There are still some
nurses who hand them out like candy and others who resist completely
even in situations the LCs might feel one is warranted!
We tried a consent form, but it was not used consistently (can't
make a mom feel guilty for using it!) and administaration had
problems with  the term "informed consent" without a doc involved.
The assessment/documenting format that the LCs use for inpatients
was where we would document shield use\, reasons, and follow-up
plans.
When we would give a shield we would recommend that mom always offer
the breast without it first and if needed try removing it after a
few minutes of active nursing.  We also encouraged lots of
skin-to-skin cuddling between feeds.  I have known a number of
kiddos who "out of the blue" for no discernable reason will suddenly
latch and nurse directly like a pro when mom least expects it
Whether mom would pump was always decided on a case-by-case basis.
In general, if we heard audible swallows and there was obvious milk
in the shield when baby was finished, we generally didn't push
pumping unless there was no progress in getting baby off shield
within the next few days.  Mom's individual emotional state was also
a factor.  Moms were instructed to contact the LCs if baby still
would not nurse without a shield after the supply was "in".  If we
had additional concerns, or there was little evidence of active milk
transfer, we would initiate a follow-up a lot sooner.  Much would
depend on what follow-up the baby's doctor was doing.  If the doc
was going to see baby within the next few days, we would ask the mom
to call us after the visit and we would plan from there.  If the doc
was one of those who rarely, if ever, see a baby before 2 weeks, we
sould schedule a follow-up weight check at least for 2-3 days after
d/c.  In the 16 years I was there (last 6 as LC only) I knew of only
2 babies who nursed entirely on a shield for many months.  The rest
would eventually "go direct".

Hope this helps and isn't too much info!

Winnie

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