I have worked as a Lactation Consultant in a hospital setting for 8
years. By and large I feel we have done our best to be evidence-based
and do what is best for the nursing dyad.  But lately I wonder.
When Dr. Meier (sp?) came out with evidence that the premie babie might
do better with holding a latch and obtaining milk directly at breast
with a nipple shield we started to experiment. And truly, some premies
did very well.  Then we expanded to aversive babies - especially those
who had gotten lots of bottles and still refused to latch even when
mother's milk came in. And that seemed to be a better alternative than
just to pump and feed.
But now---other co-workers are bringing out the shield frequently: for
sore nipples; for no latch before the milk comes in; for flat nipples.
I have estimated we go through a box of 20 in less than a month.
Sometimes 20 in 2 weeks. We see an average of 13 dyads a day.
And I have to admit I used one 3 times in April.  What do you all think
of this? And where (besides Dr. Meier) is the evidence? We have a sheet
we give out with cautions and encouraging additional pumping and
follow-up, but still I worry. Our outpatient department warns us that
mothers are coming in with babies who are still losing weight that
started on shields in the hospital.
Cheryl Muller RNC IBCLC

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