Helen writes about babies not being discharged from the maternity unit until
they are breastfeeding (admirable!)  But bemoans the fact that nipple
shields are being used to achieve a quick-fix solution, so that the criteria
can be met, for a baby who has not yet latched within 2 days of birth.  How
infuriating!

Babies I have worked with have been discharged much, much sooner because
they are able to breastfeed - at last - with the aid of a shield.  However,
one of my personal criteria is that lactogenesis II should be well under way
before I start digging in my tote bag for a shield.  This is seldom before
72 hours postpartum.   While the quantity of breastmilk/colostrum being
produced is low then continued efforts to latch the baby direct, while
"feeding" the baby with EBM expressed into a spoon (drop by drop, spoonful
by spoonful) will catch those moms or babies who simply need more
experience/practice. If the baby remains unable to latch (1) after we have
exhausted all the strategies that seem appropriate for this unique mother
and this unique baby, (2) if the mom is becoming so discouraged that she is
about to abandon further attempts to breastfeed and (3) if the milk is "in"
-  then IMHO a shield often enables breastfeeding to take place where it
seemed impossible before.  Very careful attention to positioning/latching
and techniques to facilitate milk transfer are mandatory.

I absolutely agree that continued follow-up is essential until mom and/or
baby are able to wean from the shield.  Logically, this will occur when the
original problem necessitating the use of the shield, is resolved - and the
timing can be very variable.  I continue to have problems with maintaining
contact with some of these moms, probably because they conclude that they
are "breastfeeding" and need no further assistance.  I try to get around
this by giving anticipatory guidelines at the time that I provide the shield
- stressing that nipple shields can be useful as a *temporary* tool to
assist with latching difficulties, that the "ideal" is to breastfeed as soon
as possible *without* the shield, and by giving strategies on how to wean
off it.

Pamela Morrison IBCLC, Zimbabwe