> What is the rationale behind the connection between nipple shields and
> mastitis? Does this extend to breast pads?

In my research Risk Factors for Lactation Mastitis. JHL 14(2) 101-109. I
found nipple shields were a predictive factor for blocked ducts in first
time feeders (primips). Blocked ducts was in turn the highest predictor for
mastitis. Nipple shields are often just one component of a cycle of problems
that predispose to mastitis.  Attachment difficulties and sore or
traumatised nipples are the commonest reasons for nipple shield use. These
in themselves are risk factors for mastitis as attachment difficulties
compromise good drainage of milk from the breast and cracked nipples provide
a portal for invading microbes and a mode of adhesion for bacteria (and also
usually mums put off feeds or cut feeds short due to discomfort). Nipple
shields can further compound these problems (if there is not good milk
transfer through the shield) by further inhibiting adequate drainage of the
breast, and also if not adequately sterilised, provide a source for
infection. 
I did investigate the use of breast pads in my study and didn¹t find it to
be a risk factor. 

Regards
Cathy Fetherston RM MSC IBCLC
Perth, Western Australia

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