Hi Katherine,
Have you watched her pump? I had a mom who had vasospasm with her pump but 
not with her baby. She may not recognize the color changes but you probably 
will. If that is the case, there might be some measures to be taken there.
Mary Taylor, LLLL, IBCLC
----- Original Message ----- 
From: "Katherine Lilleskov" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, March 09, 2009 10:00 AM
Subject: painful pumping


I am working with a mom whose baby is only able to extract about 1 to 1.5 oz
at the breast before getting worn out and falling asleep. I believe this 
baby
might have a type 4 TT but mom is adamant that she will wean before she will
let baby have tongue clipped. The baby's latch is quite tolerable for her,
sometimes painless and sometimes mildly painful, but pumping is 
excruciating.
She is pumping with a pump in style to maintain her supply, but finds that 
no
matter what size pump shield she uses it is painful.The hospital grade pump
was no better. We have gone up to a size 30mm. I honestly don't think she is
a candidate for a size 36 - certainly her measurable nipple tissue is not 
that
large.The suction is set at the lowest setting and we have attempted
lubricating with lanolin. Her nipples are unusual in that when you look at 
them
they appear  standard size and everted but when she pumps it seems like
nipple tissue just appears in the flange and rubs along the side, almost 
like she
has stealth nipple tissue that you don't see unless the nipple is tugged on. 
Or
maybe what we are seeing is actually areolar tissue, but you can't tell 
where
nipple ends and areola begins....As soon as she stops pumping the nipple
retracts to it's prepumping shape and looks like an ordinary everted nipple. 
I
suspect that this might be making it harder for the baby to extract milk as 
well
and am hoping that as the baby's mouth grows his suck will improve. I
suggested an exta large pumpin pal,which hasn't arrive yet, but other than
that am out of suggestions. Why doesn't medela make a size 33mm???And
even if they did, I don't know if this is a size thing or just the 
discomfort of
the mechanical pulling on her nipple.Talking her into a frenotomy is out of 
the
picture, so I am wondering if anyone has any suggestions to make pumping
more tolerable. I had this situation before with another woman who had
completely normal looking nipples, they didn't even rub against the flange 
or
anything,painless nursing, and we were completely unable to get pumping to
feel tolerable - tried everything we could. Is this caused by adhesions on 
the
nipple - what is it????? Thanks for any answers to this mystery.
Kathy Lilleskov RN IBCLC

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