Susan:

   I would encourage everyone to go back and look at the origional research...
There is NO data to substantiate the loss of a milk supply from using a nipple
shield APPRPRIATELY...

  Without question, if the baby is not latched on correctly, if the baby is
not feeding frequently enough the mothers milk supply will most likely drop...
but not because of the use of a nipple shield.

   There are 7 studies that have been done on the use of the nipple shield...

    Michael Woolridge's study in 1980 using three different shields, the
mexican hat... and a thin latex ( 1.5mm thick) nipple shield heights 1.4 adn
1.8 cm. although he found a 22% reduction in intake he considered this not to
be significant. - (18 mother baby pairs)

    Alan Lucas  using the same two latex shileds with 10 mothers found NO
signficant difference.  (10 mothers)

   Williams in 1985 using a .5mm latex shield found a significant difference
in intake but his study was about milk sampling. ( 30 mothers)

   Jackson used the same sheild as Williams but found only a 17% reduction in
intake (13 mothers)

     Amatayakul used the same latex shield as M. Wooldridge and found a
signicficant reduction in intake. (16 mothers)

      Auerbach using a shield that was 2.2 cm in height with either 4 or 1
hole scoring mothers who were pumping found a significant reduction in
intake...  ( 25 mothers)

    There are many pieces that need to be looked at with these studies - there
is no uniformity of equipement used, in some cases the shields used were for
milk sampling and were constructed very differently than those that we use in
clinical practice. there are variations in thickness, material and heights.

    All the mothers in these studies were bf without problems.. this is very
different from the situation where a mother is experiecing dificulties and we
introduce a shield as an aid...

    I think that it is arduous to be doing test weights on feeds unless there
are reasons other than the use of the shield, I also think that a mother
expereicing difficulties has enough on her plate without adding pumping
(unless like susan's mom there is a concern that her production is so high she
is at risk for other difficulties. )

    There is a fair amount of data available, expecially from australia, on
the appropriate use of the nipple shield as a tool that we should read and be
open to.
( additionally the JHL issue)

     granted this does not negate the problems of their overuse by
practicioners who do not take the time to 'fix the problem"... but this
happens with many tools... In another state that live oned of the local
hospitals appeared to send ALL babies home finger feeding.. this was their
answer to all bf problems.. was this right... but did it make ALL
fingerfeeding WRONG..

     sorry to run on so... I stand with Joy on feeling very strongly that the
nipple shield is a tool - if used appropriately it is excellent, if use
inappropriately it can create more difficulties.. but its "goodness" or
"badness" should be assigned to its usage not its being.

     Patricia