I must say that due to the fact I see so many more inverted nipples than I ever
thought possible, I have been apt to use and recommend "all of the above",
(except Hoffman) when seeing a mom.

Those in the hospital just after birth we tend to be able to latch on due to the
softness of the breasts (if the baby is not over-medicated or pooped)  - but I
have recommended that they use the shell not to pull out the nipple but to
soften the tissue around it by expressing some of the milk so the baby can grasp
it during engorgement (I know, if breastfeeding were done correctly many feel
that engorgement would not occur - but that's another discussion).  This is less
expensive than a pump - and mom is less likely to continue using it than a
nipple shield or a pump (many moms here LOVE to pump and bottle-feed "to see
what the baby is getting").

If baby is a tongue-sucker or has a poor suck I use the nipple shield - then
take it off when baby is sucking well, milk is flowing or I see signs that he
"gets it" or that the breast is yielding (softening enough to enter baby's
mouth).     Yes, I know many are  against anything artificial going into the
baby's mouth - but the other choice the mother will use is a bottle - which is
much more destructive in my mind than a nipple shield.

Jeanette Panchula, BSW, RN, IBCLC
Puerto Rico
[log in to unmask]

In Washington June 30th!