My opinion on nipple shield use is very similar to Linda's. I worked in a hospital till recently for almost 9 years, and when I first got there my ideas about the nipple shield were very similar to Mary's. Probably because when I started in the field there was a big taboo about nipple shield use. I would never ever considered using the shield at all. My opinions changed when my partner asked me what did I prefer...either that the mother leave breastpumping or breastfeeding. Oviously, my goal was to have as many mothers as possible leave the hospital with a baby at the breast...shield or not.
I do not use the shield on the first jump (though it has been commented that I do pass them out like candy...which I dont) ha,ha,ha. The only time I do not hesitate to use them right away is when the mother is already bottle feeding. Otherwise, I usually try the sandwich hold first. If it doesnt work, then I show the mother how to hand express onto a teaspoon and then feed it to the baby (mothers tend to get discourage when they see only droplets on a breastshield). I neither of these work, then I would consider the use of a nipple shield.
In conjunction with the nipple shield, I do weight testing (though I dont do it with 1-3 day olds). Many times, specially with babies with sucking problems or with prematures, I see a better milk transfer. Of course, I tell the mother the use of nipple shield is temporary, and suggest that she tries BF without it after using it for 3 days. Most of them have been weaned from the shield by the follow up.
Last, I dont know about others experience with the nipple shield, but I do not use or recommend the REG. size nipple shield, since with them I did noticed a poor milk transfer. Is like putting a cork in the baby's mouth!!!
I hate the idea of defending a plastic shield, but in my experience, it has saved many BF experiences. Still, I applaud you for defending and protecting BF.
Below are some references of the Journal of Human Lactation regarding nipple shield use. I would also suggest reading the new Breastfeeding Answer Book (LLLI) which has an update on nipple shields.
Bodley V, Powers D. Long-term nipple shield use-a positive perspective. J Hum Lact 12: 301-304. 1996.
Brigham M. Mother's reports of the outcome of nipple shield use. J Hum Lact 12: 291-197. 1996.
Clum D, Primomo J. Use of a silicone nipple shield with premature infants . J Hum Lact 12: 287-290. 1996
Elliot C. Using a silicone nipple shield to assist a baby unable to latch. J Hum Lact 12: 309-313. 1996.
Noble R, Bovey A. Therapeutic teat use for babies who breastfeed poorly. Breastfeed Rev 5(2): 37-42. 1997.
Renfrew M, Lang S. Interventions for improving breastfeeding technique. The Cochrane Library, Issue 3. 1999.
Sealy C. Rethinking the use of nipple shields. J Hum Lact 12: 299-300. 1996.
Slusser W, Frantz K. High-technology breastfeeding. Pediatr Clin North Am 48(2): 505-516. Apr 2001.
Wilson-Clay B. Clinical use of silicone nipple shields. J Hum Lact 12: 279-285. 1996.
Woodworth M. Frank E. Transitioning to the breast at six weeks: use of a nipple shield. J Hum Lact 12: 305-307. 1996.
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