Well,

I also join Babara and Karen in admitting (though anyone looking in the old
lactnet messages will see I've admitted it many times before) to the use of
nipple shields.

When I first became an LLLL (20 years ago) the nipple shields available then
were awful and did cause all that they are blamed for - loss of milk supply,
pain in nipples, etc.

When I became an LC, I never used even the newer ones as I usually saw moms at
home - they were trying to breastfeed and were having problems, but their babies
had latched on, just not well.  I never was with NICU babies (not an RN, had no
priviledges, frankly wasn't interested in doing that.), or moms still in the
hospital who were "trying" to breastfeed but who would quit at the drop of a hat
(shield??) if I didn't fix things NOW.

Since moving to PR 2 years ago and becoming a hospital-based (and clinic-based)
LC,  I use more nipple shields in a month than I used in the previous 18 years!
Did I lose my skills?  I don't think so.  I do admit to wanting/needing more
skills - I'm always ready and willing to learn - but the moms I see with whom I
use a nipple shield:
        - Mom has inverted (i have NEVER seen so many inverted nipples in a
population as I've seen here - another study - what is the cause???), flat or
meaty nipples, baby has been given bottles, refuses to nurse.  Mom says fix it
or I quit.  I put a shield on, show mom she has milk as baby latches on and
sucks milk into it, then remove it - baby latches on and we're off and running.
Could I have done it another way?  I don't think so - even after working with
moms for 45 minutes  if baby refuses and I fear a bottle will follow - I use it.
        - NICU baby - has had bottles (I haven't been able to remove them from
NICU - yet!) and refuses to breastfeed  - use small nipple shield, baby latches
on, as milk flow increases or as  baby grows, nipple shield is removed.
        - Fast let-down.  Tried all sorts of the usual tricks - nothing worked.
Used shield to reduce flow to back of throat.  Mom able to stop using shield at
6 weeks when baby learned to cope with fast flow.  Never had weight gain
problems.
        - Chomping baby - have one right now who is still on the shield.  I would
LOVE to have another LC come on down and help me fix that one!  As it is, mom's
ready to quit.  Older sibling did the same thing.  I've done everything I can
read/learn/try and we are trying to locate a chiropractor who does the
cranio-sacral adjustment, but I learned from a patient that there are only 2
trained to work with babies in PR, and one just delivered a baby and isn't
seeing patients.

        When I told my husband of Dr. Newman's  challenge, his response was:
"Well, a highly skilled person can walk a tightrope, but some of us need a
footbridge!"

        Just as with suck training and other tools - they can be overused or
misused, but I think that  to ignore their uses is to go backwards not
forwards...

Jeanette Panchula, BA-SW, LLLL, IBCLC, RN
Puerto Rico
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