Could also be retained placenta.  I'd send her back to the OB to rule this out, 
as well as hypothyroid.  Lactogensis II is what's supposed to happen after 
delivery of the placenta and if doesn't, something is seriously wrong.  
Other thoughts:  Is this her first pregnancy?  What day postpartum is she 
now?  Has she experienced the normal progression of lochia?  Was she aware 
of when her milk came in/engorgment?  Has she been pumping regularly during 
the time she has been using the shield?  Is the baby satiated by just "suckled" 
breast milk, or is Mom supplementing with EBM or formula?  Is she still 
fingerfeeding or just nursing with the shield?

I had a client once who was about 10 days pp when I first saw her. Her milk 
had not come in.  She was checked for retained placenta and hypothyroidism 
and tboth were ruled out.  She worked hard for days, doing all the "right" 
things, including Reglan and fenugreek, but she never had any milk. It can 
happen, but it's not supposed to!

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