I tried to resist responding to this feed but apparently it did not work. I am writing from the land of imperfect birth where many babies don't get that good first latch, infant's are taken away to the nursery for transitioning post csection for 2-3 hours, induction is the norm, csection rates are some of the highest in the country, and the March of Dimes gave the state an F for premature birth rates, and family may not be near and isolation is often the norm.  In my mind our job as IBCLCs is to get to the root cause of the problem. In doing this we have to fight through a jungle of signs/symptoms and use our tools appropriately to find the source of the issue. When coming up with a thought on what the cause of the problem is, blaming the tool can be a slippery slope. Tools are great when used correctly and effectively. Tools are bandaids when the root cause is not addressed. Tools are terrible when used inappropriately and can cause more problems. The nipple shield can be all of these. In my experience the nipple shield has saved so many moms from the pump and from the ever present formula in this formula feeding community. It has helped to heal sore bleeding blistered nipples in that first week postpartum (due to shallow latches on engorged breasts not from milk but from IV fluid overload) or given a mom who is tired and can barely pay attention at night an 'easy' way to get the baby on and avoid the damage from a bad latch at night that puts them on a pump due to pain as they build confidence with latch during the day. Often times this mom uses the shield for 1-7 days and then moves on. The nipple shield can also be a great tool to understanding an infant's suck- an infant who is not latching properly on a shield and pushing it out of the mouth is trying to tell us something- may be- there is an anatomical issue like tongue movement restriction cause by birth process and jaw tightness and/or a tight linguinal frenulum.  In some of these cases the baby is unable to latch without the shield due to this tightness or movement restriction and the shield may be the short term solution. Get some CST and/or an assessment by a pediatric dentist and major changes take place. Fix the root cause and no nipple shield needed. For the mom with low supply- which came first the low supply or the nipple shield- low supply from a traumatic birth with high cortisol levels causing delay in lactogenesis II and supply issues, low supply from fluid overload at birth delaying lactogenesis II til day 7-10 postpartum, low supply from pain with latch so feedings were limited in number and time, low supply from improper stimulaiton to the breast due to tongue movement restriciton, is there a hormonal cause, what is the stress like, is there a anatomical cause for mom. Blaming the shield for low supply is not evidence based. Find the root cause. In most of my experience a baby who is not latching well with shield is not latching well without it and will result in mom having to pump postfeed either way-the shield is not the cause. On the other side- a baby who is latching well with the shield and transferring well and a mom who is not ready to take the baby off the shield due to trauma and fear from those first few weeks of breastfeeding and/or other trauma in general does not have to pump postfeed as the baby is breastfeeding correctly with the shield. This mom often moves from the shield to the breast after 3 months on their own when they are emotionally ready. Tools are tools and as always they help to diagnose, explore, and discover the root cause and if abused yes they can cause harm but in general this is not the norm (at least in my world. )

Lisa Weinshenker, RN, IBCLC

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