Paula Birmingham writes about a breast refusing baby who has already been
exposed to many bottles, and who has not responded to her very best
(in-person, hands-on) tricks to bring baby to breast.  Now mother is
over-whelmed, only willing to pump and bottle feed.  Why would this not be a
good time to try a thin silicone, newborn small-size, nipple shield?  The
mother, who has not ever had success bringing baby to breast, will melt with
delight as baby looks up from the breast.  Baby will be at the breast
helping to pull out the flat nipples (which are probably the problem --
alone with being doped to the gill from birth meds, or banged on the head
from delivery, so that the mouth is not responsive to these little, flat,
nipples, but requires a big SUPER-SIZE stimulus like a bottle teat.)  So
give the baby a super-stimulus which protects breastfeeding and wait until
things improve and then wean baby off the shield.  You have nothing to lose.
Basically, this mother is going to soon find pumping so much work and so
distancing that she'll say What the Heck?  If the baby is never at breast
during the time it takes to fix the problem, the liklihood begins to
decrease that baby will accept the move back to breast.  This situation fits
my rationale of when to try a shield.

Now this next part has nothing to do with Paula, who sounds as if she did a
wonderful job trying to help this mother, and is agonizing (as all good LCs
do) when she leaves feeling unsuccessful.  But I want to talk a minute about
the continuing grief I get for sometimes suggesting nipple shields. I find
it interesting that people who find shield use scandalous have no
compunctions about renting or selling expensive pumps to mothers who have
babies who have never been to breast.  I wonder what kind of follow-up has
ever been done on outcomes of duration of bfg. when baby has never been to
breast?  Anybody ever seen that data? Anybody interested in collecting and
publishing some results from their own cases on this issue? I follow my own
cases looking at outcomes.  In my experience, the lactations don't last much
longer than a few weeks.

  The cynic in me doesn't often pop out as I believe mostly that people are
trying to do the best they can in any given situation.  But just
occasionally I wonder if there isn't a lot more money to be made in "fixing"
a situation with more expensive machinery like pumps and feeding tube
devices than there is in bringing a baby back to breast with a $6.00 piece
of plastic. I say again:  nipple confusion is not generally  a permanent
condition. Babies who WON'T nurse, CAN'T nurse.  If you can  bring them to
breast, then you buy time to fix the reason they can't nurse, or you wait it
out if it's developmental or requires recovery time.  THEN you fix nipple
confusion. In the end you may (if the mother is willing to hang in) have an
exclusively breastfed baby.  Situations  requiring the  help of an LC are BY
DEFINITION not normal.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html