HI Jan,
First I try to avoid nipple shields until babies are at least 24 hours old
and feel licking a bare nipple with expressed colostrum is more beneficial to
both.
Next I do not routinely have a mother pump when using a shield.  I do follow
them and if I find the milk supply is not where it should be or the baby is
still not a great nurser even with the shield then I have a mother pump.  It is
a case by case basis.
I do have the mother stim her nipple prior to placing the shield on.  I teach
them hand stim but if they have a pump and want to use that first they could.
Ann Perry RN, IBCLC
Boston, MA

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