I would be very concerned with the protection of my license if I
recommended or taught a mother to use a bottle nipple as a shield.
 In the hospital, years ago , it was common practice to make pacifiers out
of bottle nipples. Because of infants choking risks and I think I remember
a couple of true cases that this not only happened but due to the infants
demise and subsequent litigation there were warnings sent for this practice
to be discontinued. I think that no matter how well we think we teach the
mom to hang on to the bottle nipple, its a significantly dangerous practice
and unfair to place mothers/infants in this kind of risk. Especially for
those of us who should be using the most skilled practice techniques
available for supporting breastfeeding families. IMHO- if you feel the need
to grab a bottle nipple to use as a shield, you should be using the correct
tool designed for such use- a real nipple shield.  To me, using a  bottle
nipple as a shield is no different than teaching a mom to hook up her
vacumn cleaner to her breastpump to make it suck stronger- sounds like it
may work but fraught with real risks.
Lisa J RN CLE IBCLC
Tacoma, WA

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