Nikki,

You are absolutely right that fit can change as a baby grows.  The
pillow that we were using in my practice just before I left is called
the "Anna Pillow."  (I have no financial interest in this company or in
any other nursing pillow.)  It come in two sizes, one for singletons and
one for multiples.  One of the thiings we liked about it is that it has
three layers of foam that are removable.  That way, for a tall mother
like me, all three layers can be left in place.  Mothers who are
altitudinally challenged :-) could remove one or two layers to decrease
the height.

You are also absolutely right that it makes no sense to "fit" a mother
to a pillow during pregnancy.  It is always best done after the baby is
born and baby's size and comfort can be factored in as well.

Again you are right that pillows (like any other breastfeeding product)
can be misused.

Regarding pump flanges, a very interesting article in the most current
Medela Messenger (I *definitely* have no financial interest there!)
reports on a study by Paula Meier in which she found that >50% of her
pump-dependent NICU mothers needed a larger pump flange at the first
fitting, but after they had been pumping a while (she didn't say how
long) they refitted them and found that now >77% of them did better with
a larger size.  That goes to show that it's not just pillows that can be
outgrown.  This is true of both flange size (BTW, Ameda's larger sizes
are 28.5 mm and 30.5 mm) and also nipple shield size.

Nancy Mohrbacher, IBCLC
Lactation Education Specialist, Hollister, Inc.

> We can all agree, and be
>thankful, that there is a wider variety of flange sizes for pumps. The mother
>with 27mm nipples isn't comfortable with the 30mm ones nor the 24mm ones.
>Fitting and measurement make a HUGE difference.
>
>    Even so with nursing pillows. Many are of a permanent size; they might
>work for some babies, The comfort depends on baby's size and also on mother's
>arm length, breast-to-lap length,(or should it be nipple-to-lap length?) angle
>of nipple pointing etc. etc.
>
>    I've seen babies grow bigger than the pillow can support, and I've seen
>mothers take their breast and tug it up to baby's mouth, because baby has
>outgrown the pillow. I also don't like when the pillow becomes one more thing,
>along with hands, breast handling, baby positioning, squirming to sit comfortably
>on a sore bottom etc. etc, for an inexperienced mother to juggle.
>    I don't see that she could be fitted for a nursing pillow while pregnant
>as the two situations wouldn't be congruent.
>
>    Back to the subject of pillows. More flexible pillows are best, which is
>the style of the ones that have been recalled. Why bother buying such a floppy
>pillow? I have three bed pillows that are that flexible, and I daresay most
>people have something like that in the house. Or a folded towel.....
>
>

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