Dear Cheryl,

Without instruction in the correct latch with a nipple shield, moms may allow
the baby to "slurp" or slide onto the nipple tunnel.  That would cause the
baby to pinch the nipple tunnel, miss the areola, and is a skill that does
not transfer well to the "real thing"!  Mom's need to be taught to hold the
nipple shield at its edges and elicit MER just as with the breast alone, so
as to get a big mouthful of areolar tissue.  That is why it adding "correctly
latched" is appropriate.

> If baby were latched correctly without the shield, there might not be a
> problem to begin with.....hence it seems strange to add "correctly latched"
> with the shield doesn't it?
>
> Does getting "more" milk have anything to do with Mom "believing" that the
> nipple shield is the savior and relaxing, thus allowing optimal letdown?
>

Getting more milk may have to do with the placebo effect, but I think it's
more likely a result of better breastfeeding.  The nipple tunnel fills more
of the baby's mouth than the natural nipple alone, requiring less negative
pressure to form and maintain the seal.

> Speaking of "breast- refusing infant who has had many bottles".....isn't the
> problem two fold.....NICU's that use artificial nipples instead of the many
> other options......and standard nipple confusion which can be broken quickly
> if baby is at a healthy enough weight to endure the initial first day that
> is
> toughest if going cold turkey back to breast?
>

I think that there are many reasons why babies may have had "many bottles".
That's another discussion.  At issue here is bringing the baby to the breast.
 I agree with Barbara that a nipple shield, properly used, can be such a
low-tech inexpensive way to bridge the gap between bottles and breastfeeding,
and is often experienced as a blessing by mother and baby.  Again and again
I've seen mom's misty eyed, as they feel, for the first time, that they are
nursing their baby. The relaxation is wonderfully therapeutic. It often keeps
mom going---and feeds the baby.

> Wouldn't the use of nipple shields in the instance of flat or inverted
> nipples LESSEN the strength of the suction to pull the nipple out?
> (p.s.....personal experience of both on this issue)
>
I would never want to argue with someone's personal experience.  Every mother
and baby are unique.  But in my experience over the past decade+, many babies
are able to latch and maintain the seal with the nipple shield, thus drawing
out the nipple.

Couldn't the risk of contributing to increased mastitis also be linked to

> inadequate draining of the breast, even tho Woolridge disagrees?
>

Of course it could.  Especially if not properly used.  But still, many moms
find that an appropriately sized, appropriately used nipple shield does allow
baby to effectively compress milk sinuses and 'drain the breast'.  In some
situations, even more so than without the shield.

>
> I do agree that the creation of many problems with the use of nipple shields
> has to do with inadequate diagnosis and support to begin with....but isn't
> that the creation of many or most of the problems we deal with?

Many.  But sometimes the problem is the result of prematurity, or anatomy,
and sometimes the use of a 'tool' can be most helpful.  Always, always
suggested thoughtfully, based on thorough individual assessment, with
thorough education and diligent monitoring.  In my practice, nipple shields
have been a godsend.

       Debi Page Ferrarello, RN, IBCLC
       Breastfeeding Resources, Inc.
       Abington, PA  19001

>
>
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