Kathleen, I agree with the way you use pumps to "rest" sore nipples.  I do
this too, quite a lot, if mom is so sore that she just cannot bring herself
to put the baby to the breast.  Manual expression is an excellent
alternative to breastfeeding, but if the breast is already engorged then
this is more difficult and pumping may be more effective.  The strength of
the suction would obviously make a difference to whether sore nipples are
further damaged by a pump.  I wholeheartedly agree that you need to *see*
what is going on.  I use manual piston pumps and the degree of suction can
be varied by how far the piston is extended.   I start off *very* gently,
watching for signs of pain, or exacerbation of nipple trauma.  Pumping does
not usually make sore nipples worse (although if there is thrush the skin
may be extremely fragile and there is a risk of splitting).  My observation
is that the risk of inadequate breast drainage is high when mom experiences
severe pain during breastfeeding.  And - of the two conditions - engorgement
is potentially far more risky to on-going breastfeeding success than sore
nipples.  The use of a pump can maintain drainage, provide EBM for the baby,
and buy a little time for badly damaged nipples to heal.  In a day or two,
or five (whatever!) when the degree of pain is reduced it is easier to
review the positioning/latching to prevent a recurrence.

I found Pat Bull's comments interesting on the inadviseability of nipple
shields when there is Thrush.  I have used them for this occasionally and in
several cases they seem to have been a life-saver, reducing the level of
pain sufficiently for breastfeeding to continue while the Thrush was
treated.  However, that being said, I have recently seen badly bleeding
nipples after several days of nipple shield use when they were suggested (by
me!) for a latching difficulty.  Horrors!  We discarded the shield, went
through the positioning carefully, baby went on to the breast like a dream,
mother was delighted that there was minimal pain and no bleeding.

What I'm trying to say is that each case is different and, ideally, we
should feel free to suggest whatever interventions seem appropriate to this
particular mother and this particular baby.  Pumping can be a useful way to
rest sore nipples. Sometimes.  Nipple shields can be appropriate.
Sometimes.  We need to be flexible and creative!

Pamela, Zimbabwe