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 *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html