Re: Nipple Shield Policy - We don't have a written policy on use of nipple shields. LC's or RN super users are the only ones that can dispense a nipple shield if a mother needs one when the LC is not available. Any time a nipple shield is dispensed by the RN, a referral is placed to the LC for follow up.  
My thoughts on the nipple shield discussion. I am stunned at how much nipple shields are being maligned. Due to the effects of labor, delivery, epidural, add what you have experienced, many babies just won't latch and suckle without a shield. If a properly fitted nipple shield finally gets a baby to nurse, helps a mother feel more successful, then this tool, which is what it is, has served it's purpose. To make a generalized statement that nipple shields are overused, ignores the varied populations we work with. In my current practice setting, there would be more formula feedings if we couldn't use the shield. And, the RN's and LC's I work with do try Skin to Skin, baby led latch and tincture of time before using the shield. Mother's should be instructed on weaning from the shield but for LC's in the office setting, to tell a mother to get rid of the shield (mother's have told me this) is ignoring what is working for her and undermines the hospital LC and what she was faced with the first 2 - 3 days. By the time you see this infant, (s)he is 3 - 5 days old. 
We did research the effects of nipple shields on milk production and found them not to be detrimental. Unfortunately the resources we used are at work and I'm at home so can't list them. We also discontinued the instruction of pumping after feeding if the infant was able to transfer colostrum (how much more are we going to ask mother's to do before she says, forget it, I'll formula feed). Breastfeed with nipple shield vs. Formula feed. I'll take the nipple shield.

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