Anne,

I have had almost 100% success with the nipple shield when mom is already
giving the bottle. And mom is so grateful to be able to stop pumping and
giving bottles!  She must watch wet and soiled diapers as all moms should,
and I usually have a weight check at first any time she wants and later 
weekly just for her own reassurance.  But have not had supply problems.  It
seems the law of supply and demand (take it out, and it'll make more) that
works with the pump works as well if not better  with the baby at a nipple
shield.

When mom does not have a good supply, then I use either the peridontal
syringe or starter sns to give a "jump start" and to get baby going when
the sucking stops due to the fact the baby is used to having milk come out
with every suck.

If it were not so successful, believe me I would not use it.  I have very
strict rules for my group - sell NO PUMP to a mom when she is pregnant. 
Sell NO EQUIPMENT without my approval.  We sell stools, pillows, etc. to
pregnant moms - but if we sell one the Mini, or even the  PNS and she has a
sick baby, I will recommend a Lactina rental - and I will be considered
trying to "get her for more money".  Usually the moms come back after baby
is born as they know I won't try to sell them what they don't need (the
stools and pillows are usually gifts from Grandma - and better that than a
bunch of bottles or the Avent sterilizer!).  AND if the baby IS in NICU
they can rent the buy if they need it to work after breastfeeding is going
well. 

Please realize I was totally against nipple shields 3 years ago - my change
has been due to the evidence before my own eyes - that and the fact that
here in Puerto Rico I come across many more inverted nipples than I ever
saw in the US.  I think this is because I work in a hospital now and meet
up with moms who, after a few days of frustration, would have given up and
never looked for my help post-discharge - which was what I did before
coming here.  If I can get baby sucking well with a nipple shield I get to:
        1. start moms milk supply in a more natural way than a pump
        2. have mother-baby skin contact (belly to belly, etc)
        3. mom is not having to pump and give bottles or have someone else
give bottles
        4. baby sucks nipple into nipple shield for long periods of time
        5. during engorgement, baby is able to breastfeed
        6. usually after engorgement subsides baby goes to the breast.

So - I now use them INSTEAD of selling a pump and recommending the use of
any bottles or nipples.  Less expensive for the mom, and I believe less
difficult to wean from.

Jeanette Panchula, BSW, RN, IBCLC, LLLL
Puerto Rico
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