I read last Dec JHL with great interest, and recently our NHILCA group did
a review of the literature and  some case presentations about breast
shields.  So in a recent case, I, who was  against the old style shield,
decided to try using one.
The case in point was a gravida 9, who has breastfed all children, but
could not get the latest child to latch on after one week.  He was having
only 2-3 wet diapers/d  with a teaspoon of stool in each diaper.  Did not
show obvious signs of dehydration, but was beginning to be more sleepy, and
mom knew things were not as they should be.   Saw her yesterday to see if
we could come up with a trick to get him latched and staying on, as he
would latch and release, fuss, try again and finally, refuse.   Mom puts a
breast shell on the other breast to catch the l 1/2 ounces or so to use in
a bottle if she still can't get him nursing after a few hours.  Milk supply
is not the problem here.
I have to say here that due to this mom's experience of nursing all 8
children, I read for several hours the night before so that I would have
lots of possibilities in mind when I saw her.  I was a bit intimidated even
tho I have been an LC for 7 years...
We had only 1/2 hour for this consult.   I took 10 min to do a hx while she
demonstrated what he did at the breast.  We worked for another l0 minutes
trying different positions, ways of latching and I observed baby.
  Finally, I told her about the shield since she kept saying he would take
the bottle.  She slipped the shield on, he latched, and stayed on for the
last 10 minutes before she had to go back home so dad could go to work, and
she could meet the therapist coming to see her 6 yo!    Tears came to her
eyes as she watched him take deep swallows, and contentedly closed his eyes
but did not sleep--just kept sucking!  Tears of course, came to my eyes.
  She will weigh him in 2 d  at WIC, since the MD did not want to see him
for 2 wk.   I will talk to her by phone later today.
I will keep in touch to see how long she uses this.  She was informed of
the many cautions in the use of shields and is fully aware.  Naturally, as
a very busy mom, she is happy to get rid of any device which has the
possibility of getting misplaced!
Signed:  doubting all devices,   Michelle Scott, RD, MA, IBCLC in NH