I am counseling a mom with a six week old baby.  Mom is overwhelmed with new
motherhood in general, but is extra frustrated by having to use a nipple
shield.  She received the shield in the hospital (very long story but short
frenulum was observed, and nipple shield was given very much as a last resort
by the LC in hospital to get baby anywhere near the breast.  I can't second-
guess why the shield would be helpful in a baby with a short frenulum because
I wasn't there to see what all else was going on, nor would it be appropriate
for me to do so).
  I had not seen a mom using a nipple shield in a long time.  The last one was
probably five years ago and I definitely recall that the shield had an
*opening* at the end and the mom's nipple came out of it when baby nursed.  In
fact, I believe that the baby's tongue cupped well under the bottom of the
shield, reaching past the shield's bottom rim.
  This shield that I saw yesterday was the silicone variety - and it is *no
wonder* that the baby is very unhappy on his mother's breast without it!!  It
is essentially a bottle nipple, no other way to describe it.  Baby's output
and weight gain are still adequate but I worry about both the longer the
shield is used.  I just don't see how the baby can milk the breast very
effectively at all - he is mostly "milking" the nipple and a small amount of
areola while mom uses breast compression to make the milk come for him.
Essentially, she is manually expressing into the nipple shield, then baby
sucks it down.  It is an exhausting procedure to watch, but much improved (for
the mom and dad) over pumping and finger or syringe feeding the baby.

I have been reading Lactnet for 2.5years and have followed all the discussions
about shield use, but now it has become real for me (*and* for this mom!)  I
encouraged her to work with our local wonderful IBCLC (hi margie) who has a
much larger bag of tricks than I do, while giving her what info that I do have
about nipple confusion and transitioning from the shield.

I learn something every day - thanks for listening.
Lisa Jones, LLLL in Wellington FL