I agree, we need good research about shield use. The best 'rule' I
know of about shields is that you shouldn't introduce them unless you
or someone as good as you are can follow the mother and baby until
they no longer need it.

My own attitude toward shields has changed, from being close to
apoplexy at the very mention of them, to introducing them in some
cases when the mother seems to need to have baby in her arms feeding
and the baby is simply not able to attach or stay attached at the
breast yet. This doesn't happen on day one, it happens around a week
or so, when supply is established, baby is gaining weight, and mother
longs to get closer to baby than she can with expressing and feeding
by other means.

It also helped on our ward to have a more nuanced view of the start of
breastfeeding. People would use shields some years back if baby didn't
attach within the first 12 hours, and I do remember some cases where
the mother had been given a shield in the birthing room because
someone sized up her nipples as impossible before the baby even
sniffed at them. Now there is acceptance that some babies take longer,
and it's ok to report to the next shift that 'no, the baby hasn't
latched yet' or, more often, 'no, *I* didn't get the baby latched yet'
(groan). As long as mother is expressing colostrum by hand and keeping
baby's body close to her own, it's all right to admit they haven't
attached!

Before, mothers might be given a shield under cover of darkness and
warned not to let Rachel find out, because Rachel doesn't like
shields. Bad tactic! If staff are afraid to document what they are
actually doing, it's disastrous for quality of care. I don't like or
dislike shields per se, but I do dislike the use of all interventions
without a clear indication or plan of care. Once we had that cleared
up, people started being more open about when they were considering
shields so we could talk about it, and we were able to raise awareness
about what they are good for and what they are not. We were also able
to arrange appropriate follow-up. Doh. I also have full sympathy for
anyone working postpartum without sufficient staffing to be able to
spend the time needed to help every baby. It's draining and over time,
demotivating for staff who really care about mothers and babies. Good
luck, I hope you are organized in good unions :-(

I hadn't heard Cathy's comment about being ready to stop shields when
baby gets excited at the sight of a naked breast, so I have continued
to parrot an earlier comment of hers: 'The day the dog eats the
shield, they'll manage without it.' Anything that makes a new mother
laugh while she is floundering at breastfeeding, is good. I still
don't know what to say if they tell me they don't have a dog.

Rachel Myr
Kristiansand, Norway

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