Jan,
Thanks for raising this question.  I am anxious to see some numbers
about this.  I want to add my plea to EVERY person on LN who ever
uses shields to respond so Jan get
s some reliable figures.
I have gone back and forth on this myself.  We certainly want to
protect the milk supply, but we don't want to make it any more
complicated than necessary for the mom to whom adding the shield may
be one too many things to deal with.  I do believe that there is a
risk that less stimulation (through shield as opposed to baby's
mouth directly on the breast) may inhibit supply.  On the other
hand, I have seen many moms, even the very few who wind up using a
shield long term have no problem with supply.  If we could
difinitively identify which moms are at risk for reduced supply and
only have them pump, it would be ideal.
What I am currently doing is recommending that just before mom apply
the shield (and also just before applying the pump if she is using
one) mom roll or use her finger s to brush her nipples briefly.
Stimulation to the nerve endings in the nipple is key to keeping
those milk making/delivering hormones going.  Using mom's skin
contact is a little more like the stimulation from baby's mouth than
a piece of hard or soft plastc.
If the shield is being used very early (before hospital d/c), and
seems to be "needed" more than one or two times, I will recommend
she pump after each feeding (sometimes before depending on the
situation) at least while in the hospital.  If mom is still needing
shield at d/c, we will be in contact with her at least by phone in a
couple days and send her home with guidelines on things like
skin-to-skin cuddling, offering without each feed, try removing
after a few minutes, and especially keeping a diaper diary.  If
there seems to be a problem with baby getting enough, we will
probably recommend pumping at that time.
As I said, I have flip-flopped on this issue a number of times, so
am looking forward to what, if any, concensus there is out there on
this question.

Winnie

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