To all potential dueling opponents:

        Please note I never did say never.  Each situation has to be taken on
its own merits.  Still, I am very reluctant to admit that there is any
but the rarest situation when a nipple shield should be used in the
first few days after birth.  What cannot be done in the first few days
can often easily be done once the mother's milk becomes abundant.  In
the meantime, expressing the mother's milk and using glucose water in
addition if the colostrum is difficult to obtain, fed by cup or finger
feeding is a better approach, in my opinion, than using a nipple shield.
In the posted case of the mother with the swollen nipples, the nipple
shield seems to be the right approach to have taken, because we also
have to take into account the mother's mental processes, confidence and
lack of it and so on.  But confidence can also be transmitted through
reassurance and counselling and helping the mother see the light at the
end of the tunnel.  But if two experienced lactation consultants can
think only of 1 or 2 situations when a nipple shield really saved the
breastfeeding, this is support for my position, not an argument against
it.  In one case, the mother had already, probably inappropriately, been
started on a nipple shield.

        We have the example here in Toronto.  In June we had a conference where
a well known breastfeeding expert, to my horror, pushed the use of
nipple shields for premature babies, and we have nothing less than an
epidemic nipple shields use now.  These nipple shields are not being
used only for premature babies, but also for full term ones, and started
often on the first day of life.  Back to the bad old days.  One person's
word, and the whole system falls apart.

        As far as writing up experiences, well, do it.  We should accept all
carefully done research without preconceived ideas. But our experience
here in Toronto should serve as a warning of what can happen.  Be
careful.  The experience skilled LC using a nipple shield to save the
breastfeeding after trying everything, is not quite the same as the
inexperienced and/or unsupportive postpartum nurse using a nipple shield
to save her time.  Speaking of time, when we use a nipple shield at 2
days of age, we have not tried everything.  We have not tried tincture
of time.

Jack Newman, MD, FRCPC