I was thinking, while reading all the posts about nipple shields, that our profession is not an exact science sometimes, but an art. Each mother and baby require an individual approach in finding the right size, developing a plan for pumping and weaning from a shield. I usually will access if areola area is swollen. I found that many times it is not a flat or "fibrous" nipple, but an edematous one. Using RPS and the hand expression is what is needed for baby to latch. I also found that even if I still using nipple shield, it will fit better after I "remove" swelling. The same goes to the breast shield of the pump. I was amazed how many "hands on techniques" are used by consultants in Russia during my recent trip. They will take time to soften the areola area and the nipple. I noticed, that I am using nipple shields less frequently now.
Maya Bolman, RN IBCLC

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