Nipple shields

‘’Friend or foe’’?  (Mohrbacher 2010) Nipple shields are a tools like any other tool: ‘’good’’ or ‘’bad’’ depends largely on indication and techniques than on the thing itself. Despite the overgrowth of protocols for about any medical piece of equipment, no protocols exist for the use of nipple shields in the professional literature. This lack of protocols does not prevent any of the recommendations to use nipple shields by health care professionals, including lactation consultants. (Eglash et al 2010; in a self-reporting study, so only already interested subjects answered the questionnaires, this may influence outcomes.) The majority advice nipple shields for the use in premature infants who have difficulty staying at the bare breast and transferring adequate milk. Most concerns consider the use of nipple shields by other health care providers without sufficient follow-up care. When used for good reasons and with professional instruction and follow up the newest generation of ultra-thin silicon nipple shield s are no hazard to milk production.

Eglash A, Ziemer AL, ChevalierA: Health Professionals' Attitudes and Use of Nipple Shields for Breastfeeding Women. Breastfeeding Medicine. August 2010, 5(4):147-151.

Mohrbacher N: Nipple Shield: Friend or Foe? http://www.nancymohrbacher.com/blog/2010/9/19/nipple-shield-friend-or-foe.html

Breast milk expression

Ideally every baby is fed at mom’s breast, but there are occasions that all or part of feedings need to be expressed and alternatively fed. Milk expression can be done by hand or with a hand or electric pump. What the best way is to obtain milk from the breast depends on technicalities, but also feelings as they have impact on hormone responses. The Medela sponsored Hartmann research group in Australia stresses above all the importance of suction, where others see more effect in manual expression. Ohyama et al found that especially in the early postpartum period gentle hand expression worked best. For mothers who experience this as painful they found that the use of a 2-phase electrical pump might help get a let-down reflex. Morton compared hands and machines and found that the combination of the both got the best results. The suction of the pump was supported by the pressure of the hand, which acknowledges the notion that breast emptying is a combination of positive and negative pressure. Hopkinson & Heird compared two different electric pumps and did found differences in day to day outcomes, but in the end their effect on the maintenance of lactation was comparable.

van Veldhuizen-Staas CGA (2006): Afkolven van moedermelk. http://eurolac.net/index.php?p=15

Ohyama M,  Watabe H, Hayasaka Y: Manual expression and electric breast pumping in the first 48 h after delivery. Pediatrics International (2010) 52, 39–43

Morton JA: Is use of breast pumps out of hand? • Mothers who use ‘hands-on’ technique see increase in milk production. AAP News 2009, 30(6):14

Hopkinson J, Heird W: Maternal Response to Two Electric Breast Pumps. Breastfeeding Medicine 2009, 4(1):17-23.