I can never understand the preference to pump milk and give to babies over 
the proper application of the nipple shield if it is necessary.  Most 
mothers and babies do not have the patience for feeding on a spoon or 
through a syringe so pumped milk is given in a bottle which is  far removed 
from breastfeeding in terms of attachment and method of sucking.
I only recommend a nipple shield if I see that the baby cannot latch on 
because the mother`s nipples are either inverted or flat - or if because of 
lack of guidance while still in hospital the nipples are so damaged that the 
mother cannot bear the direct contact of the baby`s mouth.  In both cases, 
the situation will improve 1) when the mother gets help with positioning, 2) 
as the milk comes in faster and the 3) baby grows , has a stronger sucking 
reflex and has to work less hard at the breast.
A recent case is a typical situation:
Mother gives birth at 41 wks but baby weighs only 2.7k. Because of blood 
pressure concerns she is induced, has a very long and difficult labour, 
epidural wasn`t effective and she was quite traumatized after long period of 
pushing.  Baby got jaundice on second day so was kept under photo-therapy 
for 36 hours.  All the time she was pressured to provide as much fluids as 
possible to the baby because of low birth weight and jaundice.  So the 
pumping and the bottles and the supplementary formula were all in progress 
by the time I visited her when she got home by which time the baby was 5 
days old. The baby was getting frustrated and impatient at the breast so was 
feeding almost entirely from the pumped milk and the formula.
The moment I saw her nipples I understood the baby`s frustration - the 
nipples were large and flat and there was absolutely nothing for the baby to 
latch on to.  We tried all the tricks of pumping first to help the nipples 
protrude but this had no effect.
The mother was totally exhausted with all the pumping but she had a good 
supply of milk so I reinforced the positive that whichever way the baby was 
feeding she was getting her mother`s milk and the formula could be rapidly 
phased out.
But rather than just depend on pumping I did recommend the nipple shield. 
Even that was difficult because the baby was so used to getting the milk 
more quickly from the bottle.
What worked eventually was the football hold because the mother`s breasts 
were large and both she and the baby were more comfortable when baby was 
held in that position with lots of pillows to support mother`s back and 
elbows and to help the baby lie as close to her as possible in that 
"underarm" position.  When she had fed the baby in the traditional classic 
position her breasts were pressing on the baby and keeping her further away 
from the nipple.
It sounds like a lot of juggling but eventually the baby was feeding 
beautifully, those little jaw muscles chomping away and the mother felt 
comfortable.
So my guidelines about using the nipple shield are that mothers need a lot 
of help with positioning.  As for milk not getting to the baby, I could see 
and hear that the baby was swallowing and indeed when she finished and came 
off the breast, there was plenty of milk collecting still in the nipple and 
the other breast was dripping - no problem with supply here.
My other guideline is Never say Never. Try everything and anything that 
helps the baby to feed directly from the breast rather than putting so much 
effort into pumping and cleaning bottles.

Wendy Blumfield
Tutor Prenatal Teacher and Breastfeeding Counsellor, National Childbirth 
Trust UK
Haifa, Israel

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