>>most US women are ready for such labor intensive learning).
I am really hesitant to suggest either a nipple shield or a supplemental
nurser at day 5, even if the baby is on a bottle. I reckon, get EBM into
the bottle first and keep pushing the breast with EBM dripping all over it
- at least for a few days. Then very slowly raise the idea of alternative
feeding methods, >>

I feel that NOT using the Nipple shield in this situation is pretty radical.
 How is pumping and using bottles more lilke breastfeeding than using the
nipple shield? From whose point of view? Certainly not the baby's I don't
think.

How many days can the mother tolerate all this  breast refusal?  At some
level she is registering in her brain that either her baby does not like her
or that her baby is not too bright .  Are these sutble messages  a positive
thing for their relationship?

How much longer will she want to put up with  the washing of all those pump
parts and  mess and expense (pump kit and rent can cost  her up to $85
start-up and a shield is 6 bucks)

Emotionally, psychologically and financially the use of a shield in this
situation is very appropriate and  I feel much less "a radical device " as
you put it. Do you feel because the  shield was  invented more recently that
makes it more radical than a pump or a bottle?   I really don't see how a
shield  is more radical than pumping and bottles. How are you defining
radical?   Nursing with a shield is breastfeeding with a shield.  Pumping and
giving a baby a bottle is bottle feeding. What could be more "radical"?

Devices are just devices.   We need to drop the emotional tags we have on
some of these devices  and get down to the business of using  what is most
appropriate to get the baby to breastfeed before the mother  gives up.

Debby