I am hesitant to get into the fray...but wanted to mention that I have
observed a considerable difference in milk transfer when the mothers apply
their nipple shields as I was taught (I believe by Barbara Wilson-Clay, but
can't be sure) vs. how it usually is applied.
When I teach staff, I mention that it is NOT a "Mexican sombrero" to be
just placed over the nipple - it is more like a condom (just thought of
this simile - have never used it, but it's hard to describe in writing).
You need to INVERT most of it, place the nipple as deeply as possible and
then straighten it out. Nipple should be deep inside the nipple shield -
not just at the base.
Of course, at times moms have very flat nipples - especially if they are
engorged - and the breast doesn't go in deeply - then I put the baby on for
a few sucks to soften the area, remove the baby, remove the shield and
reapply. It may take a few times, but you can see/hear when the milk
transfer is occurring - AND you can test weigh (sorry, another controversy,
but the moms/babies I see need this) to see how the transfer is
maintaining.
I agree that the CAUSE of the low milk supply at this age (after the first
5 - 7 days) is probably ineffective milk removal or other mother-related or
baby-related problems rather than the nipple shield. I also agree that the
use of a nipple shield can "lull one into complacency" - which is totally
incorrect. Until infant (adequate weight gain, etc.) and mother (no pain,
aware of how to handle her situation) are doing well, follow-ups need to be
continued.
Jeanette Panchula, BSW, RN, PHN, IBCLC
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