Dear all:

Lee makes a very important point.  Despite all the good intentions in the world or even 
merely neutral intentions, one can do harm. 

In this regard, I think she pointed out an obligation that I need to fulfill.  Whether one is 
working in the field on large scale public health programs or in the hospital with clinical 
cases or in women's homes to normalize breastfeeding, we all see different parts of the 
picture.  When products are not working to specification, we need to report this to those 
who are in a position to change the situation and if they are unwilling, keep finding ways to 
encourage that change.

So, this time to directly answer her question, yes, sometimes the too tightly fitting shields 
do cause harm.  These observations are very subtle.  If you are not working with a 
population that uses pumps as frequently as occurs in my tiny part of the world or if you 
don't watch women when they pump or if you can't follow them over time -- it would be 
impossible to notice this. 

Best, Susan

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