In my case, I usually can tell the mother's "size" by just looking at her nipple. I always practice with post and pre weight testing, specially with nipple shield use.  In many cases, if I do not see a proper milk trasfer I might try another size.  In some cases, specially when we got the 3 sizes plus the additional contact nipple shield, I "experimented" with all (I documented the output in the client's chart).  I only charge the mother for one shield plus the consultation.  I keep the other shields.  I usually use them to teach health professionals or for display (autoclave...of course!!!).
   
  As for the "text book" IBCLC's, I partially disagree with the comment (though Im not one of them).  We cannot generalize.  I think most of us work through our own learnign and exsperience (so do the mothers).  Ive seen many  text book IBCLC's and CLE who refuse to use any kind of bf aids just because they learned they intefer with the natural process.    We have to keep in mind there are a lot of people out there who sell bf products and have no certification what so ever.  We are at the boom of bf commercialization.  How many mothers Ive seen that bring their own nipple shield to the hospital prior to giving birth because some store clerk told them it would prevent sore nipples.  I have also seen mothers sharing nipple shields with family members.  They even sell them on ebay!!!  While Im emailing you, I just received a call from a pregnant mom asking for nipple shields...see what I mean!!!
   
  Carmen Cabrer, IBCLC, RLC, LLLL
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  lacted.com/blog



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