Dear all, I do understand the conflicts that occur in the hospital with moms whose babies are not latching, everyone is stressed, baby is hungry, and mom needs a feeding plan at discharge. I work in the outpatient setting and I also do hospital work and see newborns at the hospital, so this is something I deal with too. First of all I know that nurses are using nipple shields even in the first 24 hours, not only in my institution, but from what I have heard from several of you who have written privately to me. I think that is ridiculous and there is no 'excuse' for using a shield at that time. As far as I am concerned, using a shield in the first 24 hours is unethical, because the risk of the shield is being taken (possible change in hormone physiology, changing infant 'target') before the baby has been given fair chance to gather up his neurologic senses to effectively latch. To me that makes absolutely no sense. So what about at a 48-72 hour discharge? Some of you have written to me about cases where there seemed to be no choice, ie mom has no access to a pump, she is going to throw in the towel, baby is frantic and needs to be at the breast to instill confidence, etc. Well, I know that there are moms who are leaving with a nipple shield, who do absolutely fine with breastfeeding down the road. However, I know, based on my experiences that not every health care provider who hands out a shield is giving proper education on the theoretic risks of the shield. I say theoretic because we have no *good quality* evidence for or against the shield, just case reports. My bottom lines are these: 1. We have no good evidence that using a shield is safe. Someone mentioned the Chertok study. But like all other nipple shield studies it is very small (n=54). It is very poorly done...it states that infant growth is no different between nipple shield users and nonusers, but the study does not describe how much the mothers were breast vs bottle vs formula feeding! Clearly the reviewers didn't know how to assess a breastfeeding article, and not surprisingly the article was not published in a breastfeeding- knowledgeable journal. Just as I concluded in my literature review of nipple shield use in 2010, I still conclude that we have no good evidence. 2. Given that we have no good evidence (other than case reports) for the *safety* of shields, I feel that families need *informed consent*. IF they are given shields at time of hospital discharge, they need to understand that the shield*could* impact milk transfer, the shield *could* make it harder for the infant to eventually latch on his own, the shield *could* cause more sore nipples, and the shield *might* be associated with a lowered milk supply. The reason I put in the 'coulds' and 'might' is because we have no evidence that the shield does not do these things, and based on our knowledge of physiology, the shield could certainly do these things. Yes, there are cases where none of these things occur, but we cannot make evidence-based clinical decisions on case reports. These families need to be followed closely to make sure that mom is maintaining her supply and the baby is growing well, and that she is taught techniques to discontinue the shield, as well as proper care of the shield. I don't expect that hospital nurses have the ability to counsel on all of these things, since they typically are not following these families longitudinally after discharge. 3. I feel that the nipple shield is the equivalent of breastfeeding fast-food. All families should be given the confidence that babies have a *deep, very strong instinctual reflex* to latch and nurse. I feel that this message is lost, and families are frantic if the baby does not latch in the first day or 2. Everyone needs to calm down. It is possible that handing over an nipple shield is like throwing a wrench into the anxiety rather than calming and reassuring everyone that the baby needs time, bonding, and some flow of intuition between mom and baby. I find that I spend a lot of time in my lactation clinic coaching moms that the baby can and will latch, and how to drum up that reflex, using STS and infant-led latch, not when the baby is really hungry, but when the baby is fed, relaxed, but interested in sucking. Yes, that might not happen in the first few weeks, but it will eventually, and everyone needs patience. But if the baby is always expecting silicone when he wriggles down to the breast, it might take longer for that baby to latch without the shield. Hospital staff are not managing these moms and babies over the next few years like I am, so they don't see the long-term impact of handing out these shields. I could go on and on. Health care providers need to avoid doing harm. Above all else, health care providers must give evidence-based informed consent so families can 1) make good decisions and 2) have tools and resources to preserve breastfeeding upon being handed a nipple shield. Anne Anne Eglash MD, FABM, IBCLC Clinical Professor Dept of Family Medicine Medical Director UW Lactation Clinic University of Wisconsin School of Medicine and Public Health 600 N. 8th St. Mount Horeb, WI, 53572 608-437-3064 (O) 608-437-4542 (fax) 608-550-3054 (pager) *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. 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