>>most US women are ready for such labor intensive learning). I am really hesitant to suggest either a nipple shield or a supplemental nurser at day 5, even if the baby is on a bottle. I reckon, get EBM into the bottle first and keep pushing the breast with EBM dripping all over it - at least for a few days. Then very slowly raise the idea of alternative feeding methods, >> I feel that NOT using the Nipple shield in this situation is pretty radical. How is pumping and using bottles more lilke breastfeeding than using the nipple shield? From whose point of view? Certainly not the baby's I don't think. How many days can the mother tolerate all this breast refusal? At some level she is registering in her brain that either her baby does not like her or that her baby is not too bright . Are these sutble messages a positive thing for their relationship? How much longer will she want to put up with the washing of all those pump parts and mess and expense (pump kit and rent can cost her up to $85 start-up and a shield is 6 bucks) Emotionally, psychologically and financially the use of a shield in this situation is very appropriate and I feel much less "a radical device " as you put it. Do you feel because the shield was invented more recently that makes it more radical than a pump or a bottle? I really don't see how a shield is more radical than pumping and bottles. How are you defining radical? Nursing with a shield is breastfeeding with a shield. Pumping and giving a baby a bottle is bottle feeding. What could be more "radical"? Devices are just devices. We need to drop the emotional tags we have on some of these devices and get down to the business of using what is most appropriate to get the baby to breastfeed before the mother gives up. Debby