Not to pile on, but I agree as well that the shield is offered too often and WAY too soon in the hospital.  What are we saying to a mom when we place a silicone shield over her nipple?  Or try to get her using an SNS on day two or three?  "Your breast/nipple doesn't work right!"  If I had my way I would ban the use of the word "flat" to describe a nipple in the hospital, period!  

Anyway, how I personally find shields useful, is when the mother comes in to the WIC clinic after having been giving bottles for days (or weeks) and wanting help with latching.  I always start with laid back crawling, in the hope that the baby will "click" with his proper instincts- and a few DO....but- the little one can get frustrated and then furious very quickly, and we have such a short window of opportunity to at LEAST show the mother what her baby can do, and or what it feels like to have that baby tug on the nipple.  The baby is seemingly looking for a familiar, firm place to get his milk- and we give him one.  Then, we do our best to encourage all the things we know are helpful- especially follow-up.  Often we issue a pump as back-up.  I am not that concerned about getting the baby OFF the shield.  Mom can decide when and how to go about it, including getting our help.  They manage all the time.  But then, my focus is trying to get a non-breastfeeding population to start understanding that they CAN breastfeed.

I would not try to rehabilitate the bottle-fed babies I see daily without a shield in my toolkit.  ...But NOT in the first three days!!

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