Due to the fact that we have new members all the time in Lactnet,
information that has been discussed thoroughly during previous years is
repeated.  At the same time, those of us who have had experience can share
any new insights into our practices, so I don't feel this is a problem.

I have used and do use them on a regular basis.  In fact, from an LLLLeader
who thought they were the most useless product that were utilized by people
who just "didn't know enough to get a baby latched on", I have become a
great advocate for their use...ever BEFORE I start with the pumping and cup
feeding or finger-feeding and suck training.  This is for two reasons:

- I have seen that the shields in fact work very much like suck training
but better - baby doesn't get milk unless he performs at the breast
correctly, he does not get milk at every suck but rather following mom's
own rhythm, and the baby also learns that milk comes when mom holds him at
the breast.  I think of them as crutches that at times are actual "physical
therapy" in that they even push down the tongue, teaching the baby to cup
the tongue and stop thrusting.

- Moms I work with are often not that convinced they want to breastfeed and
using the shield has them feeling they ARE breastfeeding right away.  (And
they are.)

I want also to respond to the need for frequent follow-up.  I do continue
to follow moms until I am sure she understands what she is doing, her baby
is gaining weight and she feels comfortable.  BUT I don't push the weaning
from the shield.  I have come to trust the moms to let go of the shield
when they see their babies "get it".  OR perhaps, like Dumbo in the story,
the shield is the little feather she holds to make sure she can fly...and
what is wrong with that? She's flying!  Most of the moms I've worked with
stop using them when they lose them or when they get tired of them...but
I've not seen them stop because they no longer work or because the baby is
not gaining weight.

The studies that show that effective emptying of the breast is the best way
to maintain supply are confirmed, in my mind, by the fact that babies who
use nipple shields, like moms who have to pump for long term (orofacial
abnormalities, long term ICU, etc.) CAN maintain a full milk supply.  

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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