This is a conundrum that hasn't been adequately studied in the literature.  I became an IBCLC in the bad old days of latex nipple shields and the "I'd never use them" attitude most LCs and LLL leaders had (with good reason, with the shields available back then.)  I've changed my opinion of shields, due to newer materials, more experience and data that shows some babies who can't properly form a nipple or grab enough tissue to get milk for whatever reason (prematurity etc) often get better transfer with the judicious use of a shield. 

That being said, the decision to pump while using a shield is usually made on a case by case basis. I talk to the moms of preterm babies and those with precarious supplies about pumping, along with some manual nipple stimulation before nursing with the shield and pumping to help supply. Those with a good supplies and full term babies often don't need to pump, and we re-evaluate based on the baby's output and weigh ins, which I do frequently on many clients who need to use shields for any reason. 

Babies who are transferring enough, don't need supplementation, have good urine and stool output, are growing well and whose mom's supply is good usually can either wean from pumping slowly, or stop, if only pumping a few times a day. 

However, if mom's supply is precarious, or baby's output is less than adequate, or the baby isn't growing well, of course we need to increase input, and often increase breast stimulation and breast "emptying" to stimulate a fuller supply. These moms would need to pump according to their needs. 

In my practice, there is no one size fits all answer to this question. Whether mom needs to pump with a shield at all, or how much depends on HER and the baby's unique situation. 

Mary Jozwiak, IBCLC, RLC
Birthwaysinc. 
Board Certified Lactation Consultant and Postpartum Doula
Chicago IL 

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