The December issue of the journal was terrific.  I too  have used nipple
shields in my  hospital practice and  private practice.  I explain throughly
to the mother why I have chosen the shield and the cleaning of the shield.
 The mothers, and dads too, are very happy with the shield because I can show
them that the mom has milk,  I can point our swallowing, and it does a
terrific job of pulling out the nipple all within one teaching session.
 Depending on the problem, once I get food in the baby, soften the breast, I
can usually get the baby to suckle without the shield even if  for only a few
sucks on the breasts near the end of the feedings.  Its just one of many
tools I use.