Barbara - Just wanted to say I applaud your observations and conclusions on
the use of a strategy which facilitates breastfeeding in an un-normal
situation.  And I like your description of a nipple shield as "a
super-stimulus which protects breastfeeding".  This is *exactly* what it is.
I have not sat down and counted success/failure outcomes, but I do know that
I have more clients now who continue to exclusively breastfeed their babies
for many months than I did - say 3 or 4 years ago - and only I'm less afraid
now to use a shield if all else fails.  Mothers often tell me later, when
the "problem" (whatever it was) is resolved, that they had been on the point
of quitting and putting the baby on the bottle.  The relief, the joy, when
the baby finally feeds at the *breast* has to be seen to be believed, and
you describe it very well.  I love it when the baby finally starts to relax
and unclench those little fists, and stops pushing and fighting, when the
mother finally sees that the baby is actually latched and (miracles!)
drinking, when the full breast starts to soften.  I agree too, that the use
of a shield can buy time and help resolve the difficulty that necessitated
its use in the first place.  I've also had to defend my use of shields, but
ultimately who can condemn the method if the outcome is a delighted mother
with an exclusively breastfed (direct at the breast, *without* a shield?)
month-old baby?  Now my critic sends me her last-resort patients!  Seeing is
believing!

Pamela, Zimbabwe