Jennifer, Sure sounds like she needs the larger flanges. Most of my moms
need the 30 mm size (of those who need larger flanges). They make a huge
difference in comfort. Also make sure she has the suction down, not up on
maximum. Larger flanges, using some lansinoh before pumping, and pumping
gently will help. Also, some moms think pumping for an hour at a time is
better than 15-20 minutes and this can create pain. What the BAB says about
milk expressed by a premie mom is 25 oz a day is excellent -- the newer
research (Medela Symphony/Classic research) is showing a more "normal"
amount is about 500 ml or about 16 ounces a day. Also, I believe something
like 45% needed the larger flanges to start out with, and 77% were using the
larger flanges at the end. My experience with WIC moms pumping for these
young premies is that they can keep up a great supply like this for about a
month before they start getting tired of pumping or stressed out when baby's
health takes a downturn and they drop to 12-16 ounces a day. And I find
about half need larger flanges (we are using Ameda which has a slightly
larger tunnel on the regular size than the Medela).

Kathy A. Eng, BSW, IBCLC

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