Mary, I believe and recommend that nipple shields should not be introduced  
until the mother is >24 hours postpartum.  I totally understand and  agree with 
you that colostrum is very difficult to pass through the  shield.  I would 
prefer that a mother sit there and hand express her  colostrum onto and into the 
newborns mouth.  
Determining when to use a shield is not just on a time measurement.   If a 
mother has very edematous areola, than I find the shield will not be much  
benefit since the baby still will have a difficult time getting a deep enough  
latch.  
There is also the careful assessment of what is really the problem at  hand.  
I have found that early introductions of nipple shields pleases the  nurses 
so they can document the baby was sucking at the breast but the reality  is 
that they were not transferring any milk and this all leads to a false sense  of 
security.
Babies have their reasons for not latching in the first day or two totally  
aside from the mom's anatomy.  This needs to be assessed first.
I base giving a shield to a mom while still in the hospital on how far  
postpartum she is (>24 hrs), how soft her areola is and ability of her  nipples to 
be pulled into the shield, the baby is showing readiness to latch and  suck 
but appears confused or frustrated, a history of introduction of firm  nipples, 
and last the mother is well informed on the reason and use of the  shield 
before it is introduced.
I think it is important to have some flexibility to each situation and not  
set down too firm of rules.
Hope that helps.
Ann Perry, RN IBCLC
Boston, MA

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