I have been following this discussion of shields with great interest.  When
I first started in practice I was not very happy to find that shields were
being handed out by L&D nurses without any backup from IBCLC or MD.  I now
have a standing order for my mother-baby pairs that shields cannot be used
without an order from me.  Since I don't feel competent to always know what
to do in those cases, I only write such an order if they've been recommended
by our IBCLC.  Unfortunately, I've had 1 case where shield use led to early
weaning, when the shield was given by L&D nurse to one of my moms when she
dropped in to visit on the maternity floor at 5 days postpartum.  She had
had a c-section and had large breasts, flat nipples, and originally a sleepy
baby.  Baby was actually being followed closely by me and the LC and was
gaining weight and latch improving.  The shield was handed to her with a
"try this, maybe it will help" type of comment.  Once baby tried the shield,
he refused to nurse most of the time without it.  Although this mom had
adequate supply and baby gained great, she got so frustrated at the
inability to wean from the shield that she weaned the baby.  She felt she
couldn't nurse in public due to the preparation required, so was stuck in
the house a lot more than she wanted.  Both the LC and I felt she and the
baby were just on the verge of "getting it" before the shield incident.  In
this case, it was handed out with no documentation, by someone with no
expertise in lactation.
When I had my own 3rd baby, a hospital LC came to visit us the same night.
She left me nipple shields and shells "just in case I need them."  I kept
telling her to take them with her because I didn't want them, but she left
them with me anyway.  Never could figure out why, as despite being a little
sleepy those first few hours, my little guy was latching fine, and neither
he or I had any anatomical issues.  Fortunately, I was an experienced
nursing mom, and had no reason to ever reach for the things.  It made me
worry, though, that she was probably handing them out to an awful lot of folks.
Like any tool, shields deserve to be used with caution and with follow-up.

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