In Woolridge's study of milk transfer with a shield in babies who were 
good nursers, the babies transferred 25% less milk...29.9ml with a 
shield, and 38.6ml without a shield. He may say it is not significantly 
different, but I think 25% less transfer can be the tip of an iceberg in 
this study. Obviously he didn't do several transfers over time, and 
daily weights to compare growth. But I don't think it is prudent to 
ignore a 25% decrease in milk transfer, until more vigorous studies are 
done to prove nipple shield safety.
It is important to remember that nipple shields are interventions, like 
drugs on the market. We want to prove their safety first before regular 
use, and we haven't with the studies done thus far. We don't want to 
assume they are fine until proven unsafe,  like we've had to do with 
formula. I realize that many people posting on this listserv have 
expressed that lactation services are an art, and that creative use of 
nipple shields can be helpful. I agree that medicine is an art in some 
respects in that there is no substitution for experience and intuition. 
However, evidence-based medicine is also necessary to reign in practices 
that are dominated by opinion and individual practice, in order to 
provide safe and cost-effective care to people.

Anne

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