I have used nipple shields for years (since the JHL came out with the research and Paula Meier's studies reinforced their use, as well as the Hartmann studies that educated me about the importance of  milk removal) with great positive outcomes.  I've worked both in the hospital and doing follow-ups in the home for weeks later - my previous posts are available, so I'm not speaking on this issue again.
   
  However, I wanted to ask/comment on the instructions of the shields and how moms are using them.
   
  Does anyone else tell moms to invert the shield and put it on the nipple then straighten it out?   Whenever I hear that the baby is latched on to the tip of the shield or that there is rubbing, it seems to me that this is not being done.  In my experience the only way to get the nipple deeply enough into the shield that there is little if any rubbing and baby latches on the BREAST (which is in the shield together with the nipple) not the nipple is to do this.  
   
  Nowhere in the instructions in the nipple shields do they tell moms to do this.  
   
  However, they DO scare moms into stopping their use - at times too soon, in my estimation.  
   
  I've had great success in increasing milk supply with the use of a nipple shield and appropriate latch, even without pumping IF the baby latches on and removes the milk effectively WITH the nipple shield.  I do like to encourage pumping at first, but have found that moms usually give it up quickly if they see their babies are getting enough milk.  
   
  HOWEVER the nipple shield is for particular situations - for example, I do not use it alone (without pumping)  for babies who are tongue-tied.  I have not seen adequate milk transfer even with the nipple shield.  
   
  Just like any tool - it is sometimes all we need, sometimes needs to be used with other tools, and sometimes it's totally the wrong thing to do!
   
  Jeanette Panchula, BSW, RN, PHN, IBCLC
  California, USA

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