>Heather:
>
>   I would like to respectfully disagree with you statement -
>
>Probably better not to use the shield - we know shields can interfere
>with removal of milk from the breast.
>
>   There is to date and to the best of my knowledge no research that
>substantiates the claim that shields interfere with milk removal from the
>breast.
>
>  Patricia


I don't think it is inevitable,  Patricia, but the research is there:

"Studies of nipple shields have shown them to reduce milk transfer 
from mother to baby" (from Enabling Women to Breastfeed,  Renfrew, 
Wooldridge, McGill, 2000, which includes the studies for all their 
'Key Practice Areas', of which the use of shields is one).

They acknowledge that clinical practice and experience does include a 
role for judicious use of shields, though.

In practice, I have seen shields to be useful in some cases, and in 
others, to almost certainly contribute to poorer milk transfer, to 
mastitis and to dwindling milk supply.

I think a shield is unlikely to help a woman with mastitis and may 
risk making the situation worse - but of course that is not a 
research-based statement, though bsed on what we know about 
breastfeeding and milk removal, I think it makes sense.  I do think 
there is enough evidence from practice to suggest that a shield which 
really doesn't 'fit' well is likely to present more problems than one 
which does fit - in fact if you get a good match between shield and 
mother, the baby can attach to the shield in a way which lessens the 
risk of a problem.

Heather Welford Neil
NCT bfc, tutor, UK

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