As an OB nurse I was the one working with nipple shields in the hospital and it was not until I became a private practice LC with a scale, that I realized how many babies get absolutely nothing through the shield. They can't get milk out. This can be catastrophic for milk supply if it not addressed. If i were writing hospital policy, I would advise pumping after every single feeding and offer any expressed milk back to baby until you can demonstrate that the baby is able to transfer milk. Ideally that would be demonstrated via a before and after feeding weight check. If this is not possible then once the milk is in and she wants to start weaning from pumping and offering expressed milk, the baby should be weighed at least evey 5 days or so, until weight gain with shield alone can be validated. I would also make sure that they understand that a baby who falls asleep very quickly at the breast and then cries when removed from the breast, may be showing signs of isufficient transfer. And count those urinations. 
Kathy Lilleskov RN IBCLC

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