I've been following the discussion of nipple shield use with a lot of
interest. Because there can be a lot of difference in birthing routines and
related mother-baby outcomes in the immediate postpartum from one hospital
to another, much less on region to another, it's distressing to see some of
the judgments being passed. Whether a baby is term or preterm, I doubt the
first inclination of any conscientious IBCLC (or conscientious partpartum
nurse) is to "slap" a nipple shield on a
mother's breast.  Unfortunately, many of us do resort to them sooner
than we might like at
times in the first few days postpartum for a number of reasons -- including
discharge before a baby is demonstrating effective breastfeeding behaviors.
The "slap on" usually comes after a period of breastfeeding "attempts" and
maternal frustration/franticness; it has to do with a baby having continued
difficulty latching and/or sustaining sucking; it has to do with a mother
who is giving up hope of continuing to breastfeed because of baby's
breastfeeding difficulty or her own nipple damage/pain. (Of course, baby's
difficulty and mother's damage are often related.)

Re: the concern of inadequate milk transfer (post-lactogenesis 2) with
nipple shield use, don't we have to look at the reason a nipple shield was
suggested in the first place? How often is shield use a "which came first:
the chicken or the egg" type of situation? Is the use of a shield actually
causing a problem with milk transfer/production or is the shield simply
masking a baby's continued difficulty with breastfeeding/suckling? The
answer may be different depending on the situation.

So there are lots of unanswered questions and the answers are different
depending on the dyad... But why was a nipple shield implemented? Is the
mother applying it correctly? Is the shield the right size (or possibly
right shape or material) for this dyad? (Wouldn't "right" size be likely to
change as baby's oral space or size changes and/or mother's breasts change
with production/lactation?) Is the baby latching deeply enough? Is the baby
sucking in an effective way, so that milk can transfer properly? Etc, etc,
etc...

Some refs on milk transfer via the shield conflict. But here are refs that
refer to shield use with term infants and include some level of mention of
infant outcomes, e.g. weight gain, length of use, etc with it. (Some focus
more on such outcomes than others.) Several of the articles were in a 1996
special issue of JHL examining shield use.

ChertoK IR (2009). Reexamination of ultra-thin nipple shield use, infant
growth and maternal satisfaction. *J Clin Nurs, 18*(21), 2949-2955.

Chertock IR, Schneider J & Blackburn S (2006). A pilot study of maternal and
term infant outcomes associated with ultrathin nipple shield use. *JOGNN, 35
*(2), 265-272.

Powers D & Bodley Tapia VB (2004). Women’s experiences using a nipple
shield. *J Hum Lact, 20*(3), 327-334.

Elliott C (1996). Using a silicone nipple shield to assist a baby unable to
latch. *J Hum Lact, 12*(4), 309-313.

Powers D & Bodley V (1996). Long-term nipple shield use — a positive
perspective. *J Hum Lact, 12*(4), 301-304.

Sealy CN (1996). Rethinking the use of nipple shields. *J Hum Lact, 12*(4),
299-300.

Wilson-Clay B (1996). Clinical use of silicone nipple shields. *J Hum Lact,
12*(4), 279-285.
Karen G

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