My opinion on nipple shield use is very similar to Linda's.  I worked in a hospital till recently for almost 9 years, and when I first got there my ideas about the nipple shield were very similar to Mary's.  Probably because when I started in the field  there was a big taboo about nipple shield use.  I would never ever considered using the shield at all.  My opinions changed when my  partner asked me what did I prefer...either that the mother leave breastpumping or breastfeeding.  Oviously, my goal was to have as many mothers as possible leave the hospital with a baby at the breast...shield or not.
   
  I do not use the shield on the first jump (though it has been commented that I do pass them out like candy...which I dont) ha,ha,ha.  The only time I do not hesitate to use them right away is when the mother is already bottle feeding.  Otherwise, I usually try the sandwich hold first.  If it doesnt work, then I show the mother how to hand express onto a teaspoon and then feed it to the baby (mothers tend to get discourage when they see only droplets on a breastshield).   I neither of these work, then I would consider the use of a nipple shield.  
   
  In conjunction with the nipple shield, I do weight testing (though I dont do it with 1-3 day olds).  Many times, specially with babies with sucking problems or with prematures, I see a better milk transfer.  Of course, I tell the mother the use of nipple shield is temporary, and suggest that she tries BF without it after using it for 3 days.  Most of them have been weaned from the shield by the follow up.  
   
  Last, I dont know about others experience with the nipple shield, but I do not use or recommend the REG. size nipple shield, since with them I did noticed a poor milk transfer.  Is like putting a cork in the baby's mouth!!!  
   
  I hate the idea of defending a plastic shield, but in my experience, it has saved many BF experiences.  Still, I applaud you for defending and protecting BF.
   
  Below are some references of the Journal of Human Lactation regarding nipple shield use.  I would also suggest reading the new Breastfeeding Answer Book (LLLI) which has an update on nipple shields.  
  

 
  Bodley V, Powers D.  Long-term nipple shield use-a positive perspective.  J Hum Lact 12: 301-304.  1996.
   
  Brigham M.  Mother's reports of the outcome of nipple shield use.  J Hum Lact 12: 291-197.  1996.
   
  Clum D, Primomo J.  Use of a silicone nipple shield with premature infants .  J Hum Lact 12: 287-290.  1996
   
  Elliot C.  Using a silicone nipple shield to assist a baby unable to latch.  J Hum Lact 12: 309-313.  1996.
   
  Noble R, Bovey A.  Therapeutic teat use for babies who breastfeed poorly.  Breastfeed Rev 5(2): 37-42.  1997.
   
  Renfrew M, Lang S.  Interventions for improving breastfeeding technique.  The Cochrane Library, Issue 3.  1999.
   
  Sealy C.  Rethinking the use of nipple shields.  J Hum Lact 12: 299-300.  1996.
   
  Slusser W, Frantz K.  High-technology breastfeeding.  Pediatr Clin North Am 48(2): 505-516.  Apr 2001.
   
  Wilson-Clay B.  Clinical use of silicone nipple shields.  J Hum Lact 12: 279-285.  1996.
   
  Woodworth M. Frank E.  Transitioning to the breast at six weeks:  use of a nipple shield.  J Hum Lact 12: 305-307. 1996.
   



             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html