Here is my observation with little experiments I've done on the nipple shield. Babies can only apply vacuum, not compression to the nipple with the shield.  The firm texture of the nipple shield can help when a baby is lifting the tongue to keep the tongue placement from out of the roof of the mouth.  The nipple shield works better when mom has good supply because there is enough force behind the milk ejection (remember Jean Cotterman's words:  vacuum is a lower pressure environment where higher pressures push the milk) and the milk is EJECTED through the shield.  When there are lower volumes, the force is less.  In addition to this, I have done some experiments where mothers pump using the pump at a setting that I have pre-measured, then add the shield and pump.  The mothers tell me that the shield's presence REDUCES the pressure by about 40 points.  This makes perfect sense when compared with some research in Australia showing that babies who generate high suction pressures causing sore nipples benefit by use of a nipple shield. It also explains why moms who use shields must pump also to preserve milk supply unless they have an extraordinarily high supply to begin with.  IN low volume situations, pre lactogenesis-II hand-expression often obtains more milk than pumping - it is just a bit more time-consuming and in our impatient world, moms may not want to spend the time needed for very long.  Fortunately lactogenesis II comes and they can pump well.  Just a little of my observation for what it's worth. 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Daphne Kuehl
Sent: Friday, March 23, 2012 2:42 PM
Subject: Using nipple shields before lactogenesis II

Hello!

I am an IBCLC as of 2011 and am still learning so much! I gave a staff education course about breastfeeding and have been challenged regarding not using nipple shields until after lactogenesis II. In my notes, due to colostrum's small amount and high viscosity, it is difficult for milk transfer thru the nipple shield. I was given the burden of providing evidence of this. It is mentioned in health e-learning courses that I have taken but I can not find "evidence" or research studies specifically about waiting until mom's milk comes in to use nipple shields. 

Any thoughts?

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