Janet raises some interesting questions.

I accept that nipple shields in the right hands and in the right
circumstances can be a tool to enable bf to continue  - well, the right
hands and the right circumstances are in short supply, too often, but
that's another story : (

I have observed many, many times that prolonged (that is more than a day or
two) use of a nipple shield *appears* to result in poor supply, as
evidenced by poor weight gain,  and sometimes, but not always, fussiness
and lack of contentment. This effect can sometimes take a few weeks to
emerge clearly, in my experience.

So, yes,  I tend to 'blame' the nipple shield, once I've checked the mother
is feeding unrestrictedly. But Janet asks, very pertinently, if the mother
is genuinely feeding on demand, then why should the shield affect supply?
If the shield cuts down the milk available, then the baby will just feed
more often...and if she's feeding on demand, then the issue will resolve
itself.

I think this does happen in some cases. I have known mothers bf with a
shield for a long time - currently, a mother with a baby of a year, who has
used the shield since birth, but not always - there have been times when
she didn't, but she has chronically mysteriously sore nipples (been through
lots of possibilities, BTW, and now she is sick of trying to treat 'em and
just uses the shield when it flares up).

I think what may happen is that it is *harder* to  feed truly
unrestrictedly with a shield. Babies seem to take longer to feed to
contentment with a shield; the whole business of using it is a chore, and
unless you get very skilled, it can be fiddly and it falls off, so you need
to be watching the whole time when the baby stops sucking and comes off, so
you don't end up chasing the shield when it falls under the chair (meaning
you have to get a clean one); the whole thing is less spontaneous, and
responding to the baby's cues is less easy. This may result in the baby
being very slightly underfed for a while with the shield, because he is
removing milk less effectively, too, as well as less frequently. This, as
we know, means less milk and poorer weight gain.

We've all seen babies who seem to *tolerate*  not being fed very well, and
they gain poorly, and  some of them lose the energy to demand feeds...I
think the use of nipple shields may make this scenario more likely.

I stress this is my thinking only, trying to make sense of my observations.

I'd be really interested in other people's thoughts.

Heather Welford Neil
NCT bfc Newcastle upon Tyne UK