Janet asks;
"How does using a nipple shield work better than just the
breast?"

It doesn't work better when baby will take and nurse at the breast.  In
this case, the function of the shield is to make the breast easier for
the infant to latch onto and keep in position in the mouth.  Premies
often tend to "lose" the breast during pauses in the nursing pattern.
They may have difficulty maintaining the nipple positioned in the mouth
so they can "milk" it effectively.  A number of aspects of prematurity
are in play here: lack of bucchal pads, reduced stamina, etc.
It has been said that babies get 20% less milk through the thin silicone
shields than at breast directly.  I know those figures have been
questioned, but it still seems that 80% of something (or whatever the
number might be) beats 100% of nothing any day.  In other words, if it's
not working directly, a shield may be appropriate for that baby at that
stage in its development.

Winnie

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