I know this question is a week old, but I'm *still* getting caught up from ILCA!

<<Now, another question--what do you think about nipple shields?  Anybody out
there using them?  Are they anathema, or are they helpful in a few, carefully
selected cases?  We haven't been using them, but my colleague has suggested
we get a few and keep them under lock and key, so that the staff nurses don't
fall into the habit of solving every problem with a shield.  I'm willing to
reconsider, if anyone has had success with them.
Judy D.>>

I wanted to add my 2 cents because I'm one of those people who "grew up" in
lactation believing nipple shields were the work of the devil.  I'm an old LLL
Leader, and heard all the horror stories about trying to wean babies off of them
and the dangers of decreasing milk supply.  I now use them very judiciously and
they have sometimes saved situations in which I am certain the mother would have
otherwise weaned.  It is my impression that all the studies that showed
decreased milk supply with shields were done with the old latex shields, not the
currently available silicone ones.  I suspect that a mother with a marginal milk
supply could be compromised when using a silicone shield, so I'm pretty careful
with follow-up, but I have not seen a problem.

I'm hospital-based, so deal with a lot of marginally-motivated mothers.  If baby
isn't on the breast within a few days, that's it.  When they work, I think a
shield has distinct advantages in that feeding is a one-step process instead of
a two-step (pumping + feeding), and baby is feeding *at* the breast.  The
shields are out of sight in my office, and I think after all this time many of
the nurses don't even know I have them.  I probably only use about 20 a year.

A couple of situations I can think of:  1) Worked with a mother shortly before
discharge whose baby was doing pretty well latching on with just a bit of help
from the nurses, but mother was absolutely unable to latch baby on by herself.
Definitely one of the klutziest moms I have ever seen at handling a baby.  Tried
every which way I could think of to position them, enlisted dad's help, but no
luck.  With a shield mom was able to get the nipple in the mouth, baby did the
rest.  Saw them back 2 days later, mom was getting much better at handling baby,
we worked on technique without the shield, they went home and did just fine
without it.  2) Consult for a mom & baby who had delivered elsewhere, about 2
weeks old, had seen several "consultants" at that hospital, had been sold every
gadget Medela makes *except* a nipple shield.  Came to see me as a last resort
before weaning.  Baby would open well, latch on, but bring the back of the
tongue up as she started sucking and lose the nipple.  (Now, had I seen her
initially I would probably have tried some of the suck-training exercises first,
but she had already "tried suck-training" with the other people.)  With a shield
baby did not lose the nipple when she sucked; due to its firmness it stayed in
position in her mouth.  Mom was thrilled at being able to stop pumping and
fooling around with all kinds of stuff.  Milk supply stayed fine, weight gain
was fine, mom & baby came to our support group for months so I saw them
regularly.  Baby was about 3 months old when she was able to nurse consistently
without the shield.

Enough raving.  I vote for judicious use in selected situations.

Becky Krumwiede, RN, IBCLC
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