Marla, you need to publish that study of the couplets you followed that used shields. There is far to little research out there on the outcomes for mothers who use nipple shields past the initiation phase. Our nurses are like the rest, wanting access to shields and thinking that is all they must do to count that as supporting breastfeeding. We have enough LC's, to see every patient, and if given inappropriately, quickly move to get rid of them. I no longer criticize the staff if given, but through teaching, let mom know why they may not be best thing for her at the time. I personally use them the most for flat or inverted nipples, and will also use them if baby has a tongue tip elevation that interferes with latch. I do not give them for soreness, tongue retraction or disorganized suck. Especailly with a disorganized suck, I will use oral exercises and finger feeding prior to going with a shield and get mom pumping first. We always, have moms do insurance pumping so that we are certain to stimulate full production, again not evidence based in literature that I can find, but has been talked about and recommended by some LC's for years. Our outpatient program follows these moms until babies are gaining well and always offer a final consult to wean from the shield. And yes, I believe we give far to many, and I've seen moms need them also as a security blanket as well. Interestingly enough, as we integrate new and younger nurses, they seemed to be more uncomfortable with actually working with and teaching latch with any considerable "hands on" approach. I actually had a newer nurse tell her even newer orientee, "oh, I never touch a women's breast to help her breast feed". I'm hoping that this is not the new trend, but as RN's assume more of a teaching, less direct role in providing bedside care, this can change how much help a mom will receive in our absence. Just my .02 LuAnn Smith RN, BSN, IBCLC _________________________________________________________________ PC Magazine’s 2007 editors’ choice for best Web mail—award-winning Windows Live Hotmail. http://imagine-windowslive.com/hotmail/?locale=en-us&ocid=TXT_TAGHM_migration_HM_mini_pcmag_0507 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]