Christine says: 
>I have seen shields used by hospital staff in an effort to "be the hero" - they got
> the baby to "latch" when lactation staff "couldn't." ..... I have seen mothers buy them and
> use them and call with desperate pleas to rescue their dwindling milk supplies.

This is the scenario I am seeing here all too often.  Baby not latching well - mother is given a nipple shield - baby "sucks" = problem solved!  Baby may get the milk that the mother lets down, milk is seen in the nipple shield so everyone is happy.  

Weeks two and three - baby is not gaining weight, often mother is engorged - but she is told she does not have enough milk - needs to supplement with formula.  The problem is not the nipple shield - is it how it is being used.  The latch has never been corrected, so all he gets is the milk from the MERs and is not "milking" the breast.  Baby is not really breastfeeding at all, but nipple-shield-feeding.  This is a common theme in my private practice (home consults).  I have recently seen some really skinny, compromised babies.  Once properly latched (with or without the shield) they eat like there is no tomorrow!

When I worked in the hospital, most mothers had Caesareans and stayed in for 4 days.  Babies who did not latch well initially were given hand-expressed colostrum and kept skin-to-skin.  Most were latching by day 2 or 3 and all by discharge.

Jean Ridler  RN  RM  IBCLC
Cape Town, South Africa

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