The newer "contact" nipple shields with a cutout at the top allow more skin to skin for mom and baby. I have also found that these shields are less likely to fold back on baby.....my observation and feedback from moms. I think, as others have said, the most important is that a mom using a shield is followed. I am still surprised to find moms who have not been told that they can try putting the baby directly to breast at any feeding to see how things go. For some, it seems they are waiting for permission from "someone in the know" to do this. I readily offer this option to moms who come to me (or by phone) and I am delighted when nursing w/out a shield occurs for the first time. Such pleasure on a mom's face!