Christine,
I do understand the reality of the setting as a basis for an LC's judgement, given the fact that I am a staunch defender of nipple shield use in the WIC office.  In the WIC office, I am presented with a mother who has not had adequate help with latching, and who has generally been offering some bottles by the time I see her, towards the end of the first week, usually, or later.

In this setting, a nipple shield is often just the ticket for getting the baby latched (of course after trying without it) so the mother can see and feel what is possible.  And we can track milk transfer with our scale.  

But a baby who is only hours old needs to have time to be skin to skin, gradually becoming acquainted with the terrain of the breast.  And if there is a medical concern for immediate calories, I can't see using a nipple shield for that purpose.  So, my belief is that the nurse's role in these early hours is to reassure, guide, and assist, mostly hands off.  Reassure that the baby does not need to eat immediately.  Guide the skin to skin process, and assist only gently with words more than hands.   And if the doctor thinks calories are needed, she can teach hand expression of drops of colostrum into a syringe or spoon.  All of this protects the breastfeeding relationship, rather than interfering with it before it can get started.  

I see no benefit to placing an artificial nipple over the mother's own nipple before the dyad has even been able to practice.  What does this tell the mother?  And what does it teach the baby?  I think it has more potential for harm than good at such an early point in lactogenesis.

More than anything, I think the reality in most hospitals is that there are unrealistic expectations for everyone involved, including the nursing staff, to have babies breastfeed, without providing the setting for it to take place normally.  I do feel for my hospital LC/ nurse friends.
Sue Jacoby
California

 

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