I see badly injured nipples from using poor pumps.  The worst of the lot
are the pumps given out by non-profit medical equipment organizations.
They buy inhalation machines cheaply and reverse the cycle.  It's like
using a vacuum cleaner to pump milk.  The cheapo
pumps from Italy are next on the list.  I tell moms in prenatal classes
to avoid buying anything with "Mama" in the name.  If she can't afford
to buy or rent a decent pump, I'll show her how to hand express.

 If the mother has nipples that look like chopped liver, I advise
getting rid of the paper breast pads until they heal.  The paper sticks
to the wound aggravating the problem.
Another thing to look for is what kind of bra she's wearing.  8 out of
10 women wear bras that are way too tight with the seam going right
across the nipple.  I'm not crazy about nipple shields for sore/cracked
nipples.  The latex seems to make it worse.  If the nipple is so bad off
that it's wide open, I would recommend hand expressing for a day or two.

Susan Nachman-Srebrnik, IBCLC
Ranana, Israel

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