Finding Jay's,  Heather's, Joy's, et al posts re nipple shields interesting
& thought-provoking. Heather, I agree with all you said about nipple
shields, and I am aware that most of the current research supports a healthy
dose of caution and watchfulness in their use. But I think back to my own
experiences: Baby #1, horrible painful cracked bleeding "hamburger"
nipples - not one word of advice re: positioning, latch-on,etc. - hosp.
handed me a funky old-fashioned nipple shield (the kind made out of glass,
shaped like the neck of a bottle with a regular long bottle nipple attached
to the end. Baby's mouth is a good 31/2" away from the breast with this
device, and not even as much stim. as with the old rubber sombrero types -
there must be others of you out there who remember this type.) Anyway, the
thing allowed me to keep nursing; I otherwise would have stopped by day 5
because of the pain. The kid grew & gained well at first, then gradually
slipped into the kind of downward spiral described by Heather - increasingly
fussy, loss of confidence on my part, no reinforcement or supporting advice,
persisted for 6 months (not exclusively) or so. Not a very positive
experience, but more so than if I had given up on my poor bloody nippes in
the first week.
Babies #2 & 3 (twins): same miserable bleeding eroded nipples, same
unbelievable nipple pain, same antique shield, same lack of BF skills, but
the babies grew and thrived and my supply never dwindled (au contraire!). I
think it took about 6 weeks, in each case, for my nips to heal enough to
ditch the shield. The twins went along to nurse without any significant
problems till 14 months.

What's my point? Seems to me (just my experience, not sure about clinical
research on this) that the difference between those two experiences was due
to the *constant* stimulation supplied by nsg. twins, and my willingness to
nurse either one of them whenever they so much as peeped (vs. trying to
"hold off" 1st baby to 3 hr. fdgs as nurses had instructed). So frequent
vigorous nsg. was overcoming the neg. effect of this ridiculous shield. But
no matter how horrid that thing was (you young'uns would die to see this
thing!), I would *never* have persisted with breastfeeding without it. I
think, and there is research to support it, that there is a place for nipple
shields, properly used within a good LC/mom collaboration. And, as with most
things, successful and appropriate use will vary. And as Pat reminds us,
just a tool.

Cathy Bargar RN, IBCLC