I have found that mothers who are good at breastfeeding sometimes have 
trouble eliciting the MER when they are pumping. It takes practice. The baby 
is much more effective at removing milk for these women. Her body hasn't yet 
learned to respond to the pump.

My suggestions: Massage breasts before pumping. Try single sided pumping for 
5 minutes a side, going back and forth, or try a manual pump. Keep working 
on this and learn to relax and trust her body when pumping. Pumping is a 
learned skill.

She will get more milk when she is at work than when she is pumping between 
nursing sessions. The body is smart and efficient so it makes just enough 
milk for the baby.

The flanges must be large enough so that her nipple is not rubbing the sides 
of the tunnel in the flange. Meaning there needs to be movement of the 
areola tissue not just tugging on the nipple. In my practice, I see that 50% 
of women need larger flanges (and I use mainly Ameda brand which is wider 
than Medela).  I find larger flanges make a huge difference in comfort and 
milk flow for many women.

Do reverse cycle feeding: nurse baby 2 x before work, possibly at lunchtime, 
immediately after work, and several times in the evening (and at least once 
during the sleeping portion of night or early morning). Go for at least 8 
drainings of the breast in 24 hours -- with 3 pumpings and at least 5 
nursing sessions. Have the babysitter give small amounts in a slow flow 
bottle using the paced feeding method. Caution babysitter against feeding 
baby too much. I usually recommend that babies only get 12 ounces while mom 
is gone so that they nurse alot when with mom. Too often the baby is given 
16-24 ounces while at daycare and most moms can not pump that much and in 
the evening baby stops nursing as often so their supply drops.

Some moms just pump at work while others add an extra pumping session in the 
late evening or middle of the night.

Some mothers do better with the style of pump that "massages" such as the 
Whittlestone or the Playtex.

Some mothers do better on a rental or hospital quality pump. The rental ones 
cycle more effectively than the purchased ones. Some mothers do better on 
one brand or another so try an Ameda rental pump. Or reverse it if mom is 
not doing well on an Ameda.

Lastly, if this is a used PIS, it may be worn out.

Kathy Eng, BSW, IBCLC 

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