Thanks for the references, Anne.  As you write, "...all 3 studies looking at milk transfer in healthy, term newborns who nurse well demonstrate a decrease in milk transfer with the shield."  

You have my wholehearted support in pointing out that introducing a shield without seeing to it that follow-up is in place is not responsible practice.   I would also agree that they are almost never introduced for a solid, indisputable reason in the first few days of life.  Baby not attaching to the breast?   Skin-to-skin contact and leisurely pace while someone goes and feeds the baby.!  Mother sore?  Fix the real problem!  Engorgement making nipple flat?  Try RPS and let the baby have a go afterwards!   Problems persisting beyond the first few days need a closer look and you may well see there is a role for nipple shields.

I have a question, having not read these articles in full myself, at least not in the last 15 years.  I see that the three studies on milk transfer in healthy term newborns are from 1980, 1987 and 1990.  I can't remember when the ultra-thin silicone shields replaced the thick red rubber sombreros, and when I first begain working as a midwife just over 20 years ago, I even encountered the blown glass shields onto which a latex bottle teat was fixed.  Do the studies specify the kinds of shields used?

I am very definitely *not* claiming that the thin shields we use today are safe or that they do not affect milk transfer or breast emptying.  If I believed that, I wouldn't worry about follow-up, and I worry a lot about follow-up.  I am wondering whether there is any evidence at all about the thin shields compared to nipple coverings we *know* are ineffective and/or dangerous.

Rachel Myr
Kristiansand, Norway

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