Anne - My experience is that a nipple shield may well help bring baby to
breast but 
1.  Mom needs to have pumped in a great supply, and she will need to
continue some pumping even with baby at brst.
2.  Milk baby will receive tends to be lower fat as low-energy infant
unlikely to nurse actively enough thru shield to draw down the fattier milk.
I've seen fore/hindmilk imbalance as result. 
3.  Not clear that baby is always learning bfdg skills, especially on a
small, narrow nipple shield.  Mouth is not making a bfdg shape.

I see it as another option to offer mom.  Am not sure breastfeeding outcome
is any better than with a **carefully** given bottle but the closeness may
be just what mom needs.

On the other hand have also seen moms struggling with shield + pump +
various tubing devices tucked under the shield to give formula supplement.
The ones who are enjoying this of course are not paying money to see me so I
only see the ones in tears over all the gadgets and major time investment.

As LCs we have a lot of tools avail to us, and the trick is to know which
options will help mom, offer them to her and then let her decide.  "The
mother is always right".   (A quote from Linda Smith if I remember
correctly.)

Joanna Koch, IBCLC, N. Ca.

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