>>In our state we are careful not to make a gadget from an appliance
intended for another use.  We could set ourselves up for malpractice
suits.<<

Trina,
The "gadget" that I  referred to was written up as a full article in JHL.
 Indeed, if I can't use an inverted syringe to help pull out a nipple, then
maybe we shouldn't use a breast pump, either, as that is not its intended
use?!  I fully understand what you are saying, and I live in the same state
that you do, but if I followed that precept to the letter, nothing would ever
evolve in our field.  There has to be some room for experimentation when the
"proper tools" just don't exist. Even doctors do this!

Regarding your use of a nipple shield to achieve the same purpose: there is
often more than one way to skin a cat, as they say.  However, nipple shields
are not without their risks, to the point that some on lactnet use informed
consent forms before utilizing them. Maybe we each need to work with what we
are most comfortable and successful with?

-Lisa Marasco, BA, LLLL, IBCLC