Joy, this is really enlightening, thank you!

I certainly see mothers who have been given a nipple shield and use it as a
poker - that is, poking it in to the baby's mouth as if it was a bottle
teat, and certainly, the baby may then hang off the end of the shield.  It
seems clear that this is a recipe for poor transfer of milk and inadequate
emptying....ergo, poor supply.

I am not worried  by nipple shields if the baby is fine, clearly thriving
and the mother is happy to use a shield as a means to continue bf. There
truly is no problem (though I think the situation merits a close eye - the
baby can appear to thrive for a while and then the issue of poor supply
rears its head maybe two or three weeks on).

I will, next time this situation appears, feel reassured if the baby
appears to latch on okay with the shield - when you say the flat part
wrinkles, do you mean sort of folds back over the baby's upper lip?  Do let
me know if I have it right. The last mother I saw who was bf with a shield
w/o supply problems did in fact have this happen. I honestly don't think I
have been observant enough in the past - I have just thought 'shield - oh
no'.

My main concern with shields remains the fact that they are given to help
with a latching  problem, instead of skilled help, and the shields  allow a
*spurious* latching success...the baby has *something* in its mouth and
gets milk out *somehow* and everyone is supposed to cheer and think all is
well.  It so often is not.

If as you say, latching correctly is just as crucial with a shield as
without, then shields are still a dangerous tool in the hands of the
uninformed and unskilled 'helper' who does not know how to recognise a good
latch.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK