The research that showed that milk transfer was decreased with silicone 
nipple shields was done with the mother using the nipple shield while 
breastPUMPING rather than breastfeeding.

No science is perfect, and as we go on we learn! We didn't know then 
what we know about suck mechanics. And there's a ton we don't know yet.

In my own practice, I individualize pumping recommendations. If the baby 
is transferring milk well, I don't recommend extra pumping (had several 
cases of miserable oversupply that taught me this was not a benign 
intervention for all women). If baby is not transferring well, we 
certainly pump and supplement. And each mom goes home with a reminder to 
watch her baby and shift strategies if something changes.

Catherine Watson Genna, BS, IBCLC  NYC

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