Aha! Maybe this is one reason why the use of nipple shields is so much in
dispute - could it be that the *design* of the shields is *different*?  Our
UK correspondents give these descriptions: "the nipple on
>the shield is *Enormous*, a super stimulus, which then lets everyone down
>because the top end is never filled by the mother's nipple, the nipple fills
>the baby's mouth because it also has a wide base so all baby can do is nipple
>suck" and " you see these great big things on mother's nipples that seem
half the size of the baby's head.....and the material used in the shield is
very inflexible and thick at the point it 'turns the corner' to become the
base."

We have a great variety here too - thick rubber, coned silicone, brims that
seem to cover half the breast - but the ones that I like (insist on,
actually) are *very* fine silicone, the "teat" part is approx 1.5 cm long
and rounded, *not* coned, and *not* thicker than the rest of the shield, and
it curves into the brim, which is about 2 cm wide (I don't use tape to hold
the shield on).  If the baby is stimulated to gape it is possible by using a
rapid arm movement to get him to "latch" past the teat-part and onto the
brim of the shield, in exactly the same way as he would latch to the areola
if the shield was not being used.  The shield and the baby's mouth need to
be very wet before latching is attempted (cooled boiled water, but EBM is
better) so that the baby's mouth can easily slip right on to the brim of the
shield and the lips are flanged, rather than sucked in (the silicone is
sticky, so if it is not wet the lips can easily be sucked inwards).  The
baby can then "milk" the breast in the usual way and - the best part - the
*rounded* teat keeps that tongue *down*.  All my instincts scream that the
coned shields could allow the tongue to raise more at the back - and that
the thicker silicone that I have seen on coned shields, which are not so
easily compressed, would not allow so much stimulation to the nipple as
there is with a rounded shield.

Just as there are pumps and pumps, so there are shields and shields.  To
condemn them all is to miss out on a wonderful last-resort tool which can
allow breastfeeding to take place in a seemingly impossible situation.

Pamela Morrison IBCLC, Zimbabwe
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