>From: Patti Spiegelberg <[log in to unmask]>
>Reply-To: Lactation Information and Discussion
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Nipple Shield Policy
>Date: Thu, 24 Jan 2002 11:20:45 EST
>
>Does anyone have in place a policy on the appopriate use of nipple shields?
>  I have not personally found them very useful with the exception of a few
>cases but staff are giving them out like candy and sending people out the
>door without follow-up.  I think a policy with guidance on appropriate
>uses, informed consent and follow-up is in order here but I'd like to not
>reinvent the wheel if anyone has something good their using that works.
>Thanks.
>
>Patti
>
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I behind on my posts so I'm e-mailing you quickly. At our hospital we have
the following in place:

1.Any mom given a shield is requried to have a full Lacation consult with
and IBCLC prior to discharge - we have 7 day a week coverage so this is
easy.

2. Any mom dc'd with a shield MUST be willing to rent a hospital grade pump
for 5 days, be willing to use it and offer hindmilk 2-4 x daily, until seen
after discharge. (pedal pumps are used if a patient really can't pay)

3. They are required to have a 2 day followup by way of a home visit (not an
IBCLC :(   ) or a weight check in our office in the hospital or by the
doctor. Most often they readily retrun to use as we have established the
bond so to speak.

4. They are told upfront this is a temporary solution, not a permanent one.

We have a nursing policy on "referral to the LC's" which cover shield use -
but since we see almost everyone, its not a big issue for us. I will say
that some nurses do give them out, when we would work harder to get a good
latch or wait it out a little, and sometimes I find even my co- IBCLC's use
them when I might not, but with good followup and good help with early
feeds, usually they are not needed for longer term use, most often for those
with  non-graspable nipples after stimulation or a baby with a very poor jaw
excursion and poor oral motor skills. We do use them often in our level
NICU.  I support their use in front of mom, even if I don't agree with
someone else's assessment, and just work real hard to get rid of it if I
can.

Luann Smith RN, BSN, IBCLC
Lactation Coordinator
Wellspan Health
York, PA

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