Allyson writes:

<Her R nipple pain is less as she thinks this is due to feeling somewhat
fuller. So my question is this--what is causing her supply to remain low?
>


Which came first, the chicken or the egg? Could it be that the supply is
low because of less effective milk removal from the right breast and
feedback inhibition to begin with?


Have you tried hand expression on the right in order to determine the
placement of the subareolar ducts (AKA "sweet spot" per Linda Pohl, or
"PWYPYF [place where you put your fingers] per Winnie Mading, or
"lactiferous sinuses" per Jean Cotterman)? Perhaps she needs a different
size pump flange on the right. This is not necessarily determined by the
visual sizing of the nipple itself. The two nipples may not differ
visually, but the placement of the above structures often differs between
the two breasts. If the placement is deeper in the right breast, a
standard flange may well produce an "upward stripping" effect during
pumping, with only the force of the MER between cycles delivering milk.
It might be worth it to try a pump flange with a larger tunnel on the
right for a few days to try for better milk transfer and subsequent
reduced feedback inhibition, depending on your assessment of the "sweet
spot" etc.


Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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