Since I work outside the hospital, I see lots of nipples that have been declared flat by hospital staff that gradually return to the normally protruding nipples they once were as postpartum edema and/or engorgement recede.  I think certain hospital practices, as well as a decline in fitness and an increase in obesity, can influence the elasticity of breast tissue in ways that might contribute to an increase in transiently "flat".  Since I also always use a scale and usually see babies on day three or later, it is often possible to determine whether the nipple shield is a helpful tool or useless gadget.  Among the mothers who were told to use the shield in the hospital, see a mix of both those babies who could not extract milk from the shield and those who did a great job with the shield.  I see far fewer babies who are able to do a good job with smaller sized shields, almost never seeing good intake with a (very small =16 mm) shield.  

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