To the concerned auntie (sorry I trashed the whole digest because of the
gobbledygook at the end) whose SIL was advised to use a nipple shield by two
LCs.  Firstly, I understand your concern - nipple shields have been given
bad press, and the belief that they will cause nipple confusion is sometimes
justified.  However, I think the pertinent aspect of scenario you described
was that the mom had inverted nipples.  I wonder if you have had the
opportunity of seeing the nipples?

While I have worked with babies who have succeeded in latching to truly
inverted nipples, and have gone on to breastfeed easily and to thrive, more
usually inverted nipples can prevent breastfeeding taking place at all in
spite of everyone's best endeavours.  In these cases, the use of an
ultra-fine silicone nipple shield can save the day and breastfeeding *can*
be made possible where it was impossible before. I feel that their use is
justified (a) after the milk has "come in", and (b) if the baby is simply
not able to latch by any other means.  I have tremendous success with them,
and I find that, with very few exceptions, moms are easily (ie *very*
easily) able to wean the baby off the shield within 2 days to 3 weeks.  In
the meantime a shield can take the frustration out of the whole situation,
the mom's relief is enormous, the baby obtains the milk, the breasts are
drained and breastfeeding *is* taking place.

It's a pity about the ABM - definitely offer this *after* breastfeeding, not
before!  I forget if you mentioned how old the baby is, but a common sequel
is that because there has been a latching difficulty the breasts become
engorged leading to partial lactation failure before an intervention is made
to use a shield.  If the mom is able to drain the breasts frequently and
thoroughly from now on so that her breastmilk supply increases then it may
be possible to slowly reduce the ABM top-ups. When a shield is being used
there is really very little difference between the shape of the shield and
the shape of a bottle teat, but again, I don't have too many problems
weaning babies off teats either.  If this was my client I would give
suggestions to work towards reducing the ABM supplements first.  Once the
breastmilk supply was sufficient and the baby was gaining well, then it
would be easier to work towards weaning off the shield too.

In defence of the LCs concerned, what you described doesn't sound like as
much of a problem as it may at first appear.  The most important factor
(over which neither you nor the LCs have any control) is maternal motivation
- that magic ingredient that keeps a mom patiently teaching/coaxing the
baby, and putting in the effort to maintain/increase her milk until it all
comes right.
Best wishes to all.

Pamela Morrison IBCLC, Zimbabwe
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