Jack,
I laughed pretty hard at your invitation to have it out at ten paces with
nipple shields.  What will we do with those pieces of silicone?  Hurl, spit,
or make noises through them? :-)

I sheepishly admitted to Kathy Auerbach 4 years ago that sometimes, very
timidly, when I'd done all I could and all my skills had failed, I would use
a thin silicone shield to delay, and hopefully prevent, imminant weaning.
"You must write this up!" she ordered.  She pestered me for two years, and
it took me another two of researching, reading and re-writing to generate an
article reviewing a years worth of charts to try to develope a sense for how
use of shields influenced lactation in high-risk-for-weaning women.  I think
this project took me so long and was so painfully difficult because I knew
the issue was contraversial, and that saying something positive about any
artificial teat was not going to be popular. Yikes, Revisionism!

I hope that we can be pragmatic about tools, recognizing their limitations,
but not eschewing their use out of pride or from a belief system stance.  It
would be ridiculous to go back to slapping a shield on any woman who
experiences problems which are fixable with other measures.  I have to hope
the professionalism of our field has evolved to a point that shield use will
not be uninformed.  If shield use suddenly escalates inappropriately, I
would be tempted to scold the careless HCPs and LCs rather than blaming the
tool.  It has limited, but perfectly acceptable indications.

I guess writing the article means I am willing to be publically humiliated
in the interests of science, but I would hope that oponants of shield use
spend the time to defend their arguments with research and further
methodologically based exploration of the issue.

In the meantime, well, we're nothing if not opinionated on this list.
That's what keeps it lively!

Barbara