Dear All,
I do use nipple shields sometimes. I am in private practice so I am 
seeing mothers 3 days to 12 weeks (sometimes more!) post partum.

For the non-latching baby, we always work on better latching and 
positioning first. Skin to skin is consistently part of my care plan 
pretty much no matter what is happening. Having mothers and babies enjoy 
each other is very important.

For the non-latching baby I will suggest mothers stop "trying to 
breastfeed" and just do skin to skin and pump until I can see her. 
Trying to latch wasn't working anyway so why should we keep doing a 
behavior and expect a different result? Often the baby feels much better 
about trying to breastfeed once I see them (they seem to have short 
memories) and is able to latch on. This is for the baby who has been 
shoved to the breast one too many times. You know, the ones who start 
screaming as soon as you start putting them in the direction of the 
breast? They seem to have developed a psychological aversion to being 
near the breast from so much abuse. And yes, I think it is abuse.

I consider nipple shields to be "training wheels" for breastfeeding. If 
they help, great! If not, don't use them.

I always do careful pre and post weights and even if the baby takes a 
full feed I will have the mother pump 2-4 times per 24 hours after feeds 
until we are feeling confident the baby can drive the milk supply with 
the shield. Usually for 4+ days. I am paranoid about my mother losing 
the milk they have worked so hard to create.

If the baby doesn't take a full meal, the mom should (in my mind!) pump 
8 times per 24 hours after feeds and she needs to supplement they baby.

Sometimes the shield really only allows the baby "to be at the breast". 
Not much milk transfer at all BUT mom is thrilled the baby is nursing. I 
tell the mom that right now the baby is breastfeeding for fun and 
comfort which is fantastic but not a meal. So breastfeeding is not about 
milk transfer right now, just enjoyable for mom and baby. And she needs 
to remove her milk another way until the baby is able to do their work.

Aside, I think if we focus on having breastfeeding be enjoyable for mom 
and baby our odds of sustaining breastfeeding, even if baby doesn't get 
all their milk that way, goes sky high. I love Tina Smillie's idea of 
supplementing before breastfeeding and have breastfeeding be dessert. 
Let's have fun while breastfeeding!

We also then have to figure out why does the baby need training wheels. 
Too many bottles? They like that super stimuli? Tongue/lip ties? Body 
work? Some sort of suck training? Not enough fat in their face? Preterm?

A few days ago I had a mom in with a baby that had short sucking bursts 
with LONG pauses between. Mom was compressing and massaging like crazy 
to keep the milk flowing but the baby kept falling asleep. We used a 
shield and the baby was able to sustain sucking and transfer more milk. 
Now we need to figure out why this tool helped her so much. Doctor says 
there is not tongue tie, of course. So, more body work (notice I said 
more. It is a go to for me), more skin to skin, and exercises to help 
build strength and coordination. Time. She will get bigger and more 
mature (she was preterm and is not at her due date yet). I didn't 
suggest a shield until my 3rd visit with her when she was 10 days old. 
It seems to be helping according to my observations and my scale. Mom 
was very eager to try it. Someone had told her they thought it might 
help. This is a problem when we have a mother coming to to us asking for 
a shield.

Do babies need shield for the first few days? I doubt it, but don't work 
in the hospital. Can a baby transfer colostrum with a shield? I don't 
know but would have the mother hand express or pump to tell her body we 
want lots of milk in either case and feed that milk to the baby if that 
seems to be appropriate.

Some people have more skills to help babies latch without shields. I 
envy people like Nikki Lee and Alison Hazelbaker who are trained to do 
body work right then and there with their babies. They have more tools 
in their tool boxes to help their babies. Becoming trained in this 
modality is on my list but I haven't had time to do it yet. Too busy 
becoming a Motivational Interviewer Trainer and a better presenter! 
Until I am trained I will continue to refer to other people who might be 
able to help.

Other thoughts?

-- 

Barbara Robertson, MA, IBCLC, RLC
The Breastfeeding Center of Ann Arbor
bfcaa.com

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