Hi All,
I must comment on Debbie's comments about "purists" and suck training, etc.
She writes:

I feel  strongly that many moms are often abused by well meaning "purists"
who force  moms to learn complicated things like suck training (Please
whoever came up with that annoying invasive and threatening idea
 substantiate the proceedure) cups, tubes syringes and even SNS (ugh)Moms are
soooo stressed out and exhausted.  How are these PURE???

Debbie, I must respectfully disagree, wholeheartedly, with your thoughts.
As far as "suck training" goes, it is not annoying, invasive or threatening
when done in an appropriate manner with the appropriate subject.  It is also
VERY easy to do and can work beautifully in situations where a nipple shield
would have no effect.  Other alternatives also have their places.  You
cannot use a nipple shield with a preemie who can't latch, but, rather than
put a bottle teat into the babys mouth, and teach them to suck incorrectly
and cause them all sorts of other problems known to be associated with bot
feeding and preemies, you can teach them to feed from a cup.  Also, if you
have a mom with little or no milk supply who wants to feed her baby totally
AT breast, then SNS's or Lactaids are a godsend.  Nipple shields have their
place in the world of BF as do all these TOOLS.  That is what they all are.
TOOLS to help us do our jobs better, to help moms succeed at breastfeeding
their babies. Some moms I have counseled (while working with an LC) have
hated using a nip shield, but loved the SNS, others preferred using a P
Syringe.   Still others preferred to pump and bot feed only, rather than
ever put a baby to breast.  We have the job of deciding what tool will work
best for which mom, and the mom has the job of speaking up and saying what
she can and cannot do.

Let me tell you a couple of stories.
1) I know a mom who desperately wanted to BF her babies.  She had 7 kids,
was never able to produce any milk for them.  She used a Lactaid for the
first 5 then an SNS for the last 2.  She had a classic case of lack of
glandular tissue.  She was the first real consult I ever sat in on.  I was
so excited about it I wrote it up on Lactnet 2 yrs ago.  Even if she had
been able to get a milk supply of more than 2 drops a day, she never would
have been able to wear a nip shield because one nipple was about 1 in long
and the other was about 1.25 in long and both drooped!  Tube device saved
the day!
2) Client had a baby who would NOT suck correctly.  Tried a nipple shield,
no luck.  Mom didn't want to try suck training (tho why, we never did
understand).  She was open to cup feeding.  Gave this baby about 3 days of
no suck stimulation, except dad would let baby suck on his finger every now
and then (I know, suck training, sort of).  After 3 days, this kid wanted
mommy so bad, that when he got the chance, he opened up, latched on, and BF
great until he was 2 when he weaned.
3) Mom presented with nipples in terrible shape.  They were in such bad
shape that she developed bi-lateral mastitis, and had infections in both
nipples.  (It took 2 months for her nipples to heal the damage was so bad.
Mom has scars to this day)  Baby presented with a classic bubble palate, and
a suck that was a mess.  This kid was taking moms nipples and stuffing them
into his bubble, result, hamburger for nipples.  Mom got really lucky, was
seen by an expert in the field.  That expert taught her how to train her
baby to suck properly.  It took time and effort, but mom was determined to
try and BF this kid, or at least pump and bot feed long term.
End result of suck training: When breasts were healed enough to put baby
back to breast, baby latched on and BF like a champ, like he had been doing
it since day one.  No nipple shield would have helped this mom.  Her nipples
were to severely damaged and the suck was too messed up.  That child, at 35
mo old, is still BF along with his 5.5 mo old brother today.
BTW, I am the mom in #3.  The expert in the field was Chele Marmet.  Suck
training is an excellant tool.  I have used it many times since I entered
this field 2.5 yrs ago, sometimes it worked great, sometimes it didn't help
at all.  It depends a lot on the detrmination and dedication of the parents.
(this goes for all tools of this trade)

Every tool has its place.  Every tool has its good points and its bad
points.  Babies can become hooked on cup feeding, bottle feeding, finger
feeding, nipple shields (had a few of those, too), and tubes at the breast.
It all depends on how each tool is used.  I think it is wonderful that you
have never had a client whose baby got hooked on a nipple shield.  Many of
us have.  Many of us have also had moms who had drops in their milk supplies
due to the shield.  The moms have had to do extra pumping and supplementing
to maintain their milk supply and babies weight.
IMHO, it is inappropriate to bash other tools.  Even if we don't think they
are worth using, it just isn't right.  What works for one may not work for
another.  Chele Marmet is very pro P-Syringe and rarely uses and SNS, even
though she helped design the SNS.  She feels that they do not work as well
as the P-syringe, and that they can cause more trouble than they are worth.
However, she used to use them (SNS's) all the time.  I, however, disagree
with Chele.  I found the P-Syringe to be difficult to work with when I was
going thru my BF Hell described above.  But other moms have found it easy to
work with.  SO they use what works, and so do I.  BTW, I do offer P-syringes
to moms as an alternative when appropriate.
Enough rambling...So there is my .03 worth.
Don't go back into hiding, tho!  Stay out and join in.  The more the merrier!
Jay

PS I also didn't like "purists" as a label for those who use these tools.
One could say that someone who only uses a nipple shield is a "purist" in
her own area.  But then, what is so "pure" about a piece of silicone over a
mothers breast?
None of these tools is any substitute for the real thing.  However, if it
works...great!  The Key here is to be flexible and use your best judgement
when working with moms and babies.  No one tool will fix everyones problems...
Jay Simpson, CLE
Sacramento, CA
"No Miracles performed here, just a lot of love and hard work."