Debra Swank, Thank you for your knowledgeable and thoughtful post.I realize pumping after feedings is extra work for a new mother, yet I feel this is very important during the early days of shield use. I talk to mothers about "putting in a lot of work in the front end, then it will become easier after 3-7 days."Most mothers I work with are happy when a plentiful milk supply has been established. Babies using nipple shields are followed up a few days post d/c in our outpt clinic and usually the pumping can be adjusted down to 1-2 x per day or mother can stop.  Unless baby is not transferring much milk, then mother will need to pump after several feedings a day to help increase milk supply and to provide her own milk for supplements. Baby may need 2-3 or 4 appts in the Breastfeeding Clinic, until baby is getting full feedings from the breast.Dr Jane Morton has said 'It's all about the milk supply."Susan in Minnesotarn ibclc
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