In a message dated 12/29/1999 8:23:58 PM Eastern Standard Time,
[log in to unmask] writes:

<< Does anyone out there think that the standard hard plastic pump accesory
kit
 flanges we use fall short on completely emptying all areas of the breast. I
 have had two cases of abscesses developing in the areola region right where
 the edge of the pump sits. When you think of manual expression and the baby
 nursing it is obviously more of a massaging action. Does anyone have
 experience with the softer silicone flanges that actually massage the breast
 versus the hard plastic flanges? TIA Lisa >>

Dear Lisa and Everybody,
Now that larger breastshields are readily available, I have found many more
mothers than I previously realized need them.  So I am led to believe that it
is not just a massage action but the size of the tunnel of the pump flange
that has a dramatic effect on pumping comfort and the effectiveness of milk
removal.
If a mother complains of ANY discomfort during pumping and I see her nipple
filling the tunnel completely, turning red or blanching, we sterilize one of
the larger shields and give it a try.  Comfort is often immediate and the
larger shield is needed by the mom.  It makes a huge difference in how much
milk they can plump out also.
When we think about it the baby not only massages when he breastfeeds, he
opens his mouth wider depending on the size of his mother's nipple and
areola.  Babies do not come with only one or two sizes of opening of their
mouths.
Anytime a mother complains that pumping hurts at all or does not get the milk
out well, I want her in my office so I can SEE what is happening.  The
nipples do not have to be enormous to need the XL shields, just wide enough
to be tight in the flange.
Jane Bradshaw RN, IBCLC
Lynchburg, VA

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