To the concerned auntie (sorry I trashed the whole digest because of the gobbledygook at the end) whose SIL was advised to use a nipple shield by two LCs. Firstly, I understand your concern - nipple shields have been given bad press, and the belief that they will cause nipple confusion is sometimes justified. However, I think the pertinent aspect of scenario you described was that the mom had inverted nipples. I wonder if you have had the opportunity of seeing the nipples? While I have worked with babies who have succeeded in latching to truly inverted nipples, and have gone on to breastfeed easily and to thrive, more usually inverted nipples can prevent breastfeeding taking place at all in spite of everyone's best endeavours. In these cases, the use of an ultra-fine silicone nipple shield can save the day and breastfeeding *can* be made possible where it was impossible before. I feel that their use is justified (a) after the milk has "come in", and (b) if the baby is simply not able to latch by any other means. I have tremendous success with them, and I find that, with very few exceptions, moms are easily (ie *very* easily) able to wean the baby off the shield within 2 days to 3 weeks. In the meantime a shield can take the frustration out of the whole situation, the mom's relief is enormous, the baby obtains the milk, the breasts are drained and breastfeeding *is* taking place. It's a pity about the ABM - definitely offer this *after* breastfeeding, not before! I forget if you mentioned how old the baby is, but a common sequel is that because there has been a latching difficulty the breasts become engorged leading to partial lactation failure before an intervention is made to use a shield. If the mom is able to drain the breasts frequently and thoroughly from now on so that her breastmilk supply increases then it may be possible to slowly reduce the ABM top-ups. When a shield is being used there is really very little difference between the shape of the shield and the shape of a bottle teat, but again, I don't have too many problems weaning babies off teats either. If this was my client I would give suggestions to work towards reducing the ABM supplements first. Once the breastmilk supply was sufficient and the baby was gaining well, then it would be easier to work towards weaning off the shield too. In defence of the LCs concerned, what you described doesn't sound like as much of a problem as it may at first appear. The most important factor (over which neither you nor the LCs have any control) is maternal motivation - that magic ingredient that keeps a mom patiently teaching/coaxing the baby, and putting in the effort to maintain/increase her milk until it all comes right. Best wishes to all. Pamela Morrison IBCLC, Zimbabwe mailto:[log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html