Jean said:
"The size of a pump flange in relation to the size of the nipple is not
necessarily a determinant of efficient compression on the subareolar ducts,
by whatever name we choose to call them. If those ducts are buried somewhat
more deeply in the connective tissue, a larger flange may offer more
effective compression on them."
THIS IS SO TRUE!!! (sorry to be yelling, but we need to "wake up" and
realize that the flange tunnel is NOT there to "stimulate the nipple" or
whatever it was we used to hear/say! (I remember clearly hearing a
presentation years ago that said that we should make sure that the nipple
"moves along" the side of the tunnel to "stimulate the release of
oxytocin".)
I've seen only short parts of Paula Meier's presentation on pumping and one
of the videos she has showing how breasts look when they are correctly being
pumped...but I think she has a good "beginning" of this, and hopefully will
publish research to start a dialogue and evidence-based information.
When I was in Puerto Rico a mom came by whose breasts were symmetrical
(except for a slight variation - but not anything spectacular as you see in
some slides). However, when she pumped, one breast released milk just fine
- the other not at all. With hand expression (which I began to show the
mom, but at 4 days postpartum she was overwhelmed and weepy with a baby in
NICU) I could feel that her breasts were full and I was able to express
milk, though the ducts were very deep. I happened to have a big, glass
flange that I had used ONLY with moms with ENORMOUS breasts - but it was
clean, available and I thought why not...well the milk POURED out!
Just as breasts are asymmetrical (as are eyes, ears, etc.), why not the
internal organs and ducts?
We need to be aware of these differences and variation and be skilled in
recognizing what works and what doesn't. (Perhaps a pump flange will need to
be designed that changes in size? Why not? Pumps now offer a large
variation in cycling and suction!)
Now that breastfeeding is being promoted for ALL moms - we need to learn how
to deal with problem situations that before used to cause moms to just quit.
AND now that we are dealing with a large number of obese women (at least I'm
seeing that in my work), we need to be aware of how to help moms with large
breasts, or at least breasts that have a lot more fat perhaps between the
skin and the ducts and not just nicely tucked in under the glandular tissue
as you see in some diagrams of the breast!
Remember we used to say "the size of the breast doesn't matter - you can
still breastfeed even if you have small breasts - well, frankly, small
breasts are the LEAST of my problems when getting good latch-on, effective
milk transfer and when necessary...pumping!
Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, California, USA
PS - frustration of the day
An IBCLC called me, very upset - legitimately so! A mom/baby were seen on
day 3 in a pediatrician's office - baby had lost more than 10% of birth
weight. They decided to "assess" breastfeeding ... By pumping the mom,
getting one ounce of milk and feeding it in a bottle - they weighed the baby
before and after this "feeding" ...and reported a one ounce weight gain!
They didn't refer the family to the LC!
You might think it funny - or you could consider it a check on the
calibration of the scale - if baby hadn't been hospitalized due to [lack of
breast milk] jaundice... Bili over 22!
(My physicist son would be SO glad to hear that the Law of Conservation of
Matter is still in effect!)
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