I will rarely criticize anyone for using shields when they are following the
dyad.
Absolutely all my experience with shields is with the newer generation, thin,
silicone ones.  I see babies who won't take the breast without a shield, and
who aren't thriving, for example because the breast is understimulated due to
incorrect shield use with no follow up.  I see mothers with chronic
engorgement until involution sets in, due to ineffective milk transfer.  I see
soreness, mastitis, thrush, and a lot of hassle that often could have been
avoided by better attention to latch in the first go-round.  These are the
cases where shields are dispensed uncritically to babies for whom the benefits
of shield use have never been demonstrated.
The true need for a shield should be a red flag to us.  Recommending shields
obliges us to remain in contact until we are sure the breastfeeding is not
threatened or undermined by them.
I often hear at work 'But the baby took 15 ml with the shield!' If this is a
baby who hasn't been taking anything because of declining to latch, then of
course that is some kind of progress (though I am inclined to see it as one
step forward, two steps back).  I've taken to practically insisting these
women, often on the third post partum day or so, pump after feeding with a
shield.  Then I can go to my colleagues and say, 'maybe the baby took 15 ml,
but she just pumped another 30 right after the baby was finished, and if there
had been an effective latch, chances are the baby would have gotten much
more.'  The point of pumping in these cases is to protect supply, not
necessarily to increase baby's intake.

It is easier to get a baby off shields if supply is bountiful.  Among the
exceptions are babies with laryngomalacia, for whom shields may be a saving
grace.  A study on that would make a dandy master's thesis, I think.
Rachel Myr
not planning to do MY master's on that, but hoping someone else will!

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