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Subject:
From:
Carol L'Esperance <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 21 Feb 2000 10:48:43 -0800
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Interesting discussion everyone! I was one of those that wrote never use of nipple shield. Had it published in a chapter of a nursing textbook! I have learned to never say never. We now have some very thoughtful articles, summaries of clinical reports of the use of nipple shields. (Entire Journal: J Hum Lact 1996 (12). These report babies who do gain weight and supplies that are not compromised. IF I remember correctly there was a great variance as to how long they were used--sometimes it took months to transition the baby to the breast, but they did transition.  I think we need to look critically at this issue:

Do the shields used today cause a reduction in the amount of milk the baby receives? Older studies used older "Mexican Hat" shield.

What criteria do we use to initiate a shield? What criteria do we use to initiate finger feeding, cup feeding, and a bottle nipple to supplement when a baby cannot attach?  In my experience, I use a cup if the baby is in the hospital. Later, if the baby has had a bottle, she is less likely to take a cup. However, my major criterion, in all honesty, as to what type of alternate feeding device to use is the parents---what they feel comfortable doing.

If nurses in the hospital are using nipple shields, why not develop protocols and standards for them to follow:
1. First try to call an LC
2. Nipple shield used only when unable to get baby to attach and an alternative feeding device is not feasible or wanted by the mother.
3. Follow-up by an LC is mandatory.

Or something like this.

Also, we need further research and clinical reports that give us further information about the use of nipple shields!
Thanks everyone for all you wonderful wisdom and experience!
Carol L'Esperance, RN, MSN, IBCLC, Albuquerque, NM, USA

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