> Nature didn't plan ahead for pumping and so mothers sometimes have to play around with different flanges. There are not a lot of strict rules about sizing flanges, and the pictures in some pump instructions look tight to me, especially if mothers interpret the picture to be the breast at rest before the machine turned on -- some breast tissue really expands with suction.  Have you actually had a chance to see her pumping?

> With pain and damage, I would be more likely, instead of going smaller, to try larger flanges, with lots of lubrication (even if she doesn't have unusually large nipples).  Sometimes just moving a little more tissue, more freely, hits a "sweet spot" for getting milk to flow.  (The 24 mm flange seems tight on many mothers -- maybe the 27 should be the standard, and it seems that 30 mm flanges work the best more commonly than one would think).  The Pumpin' Pals flanges, that have more of a slope than a sharp angle, could be another thing to try.

Margaret Wills, IBCLC, Maryland



> 
> Date:    Tue, 20 Jan 2015 12:06:42 -0800
> From:    Michele Crockett <[log in to unmask]>
> Subject: Another one!
> 
> PTP:  Mom with 8 week old baby.  I saw them about 3 weeks ago for latch
> problems and sore nipples.  Mom had quit breastfeeding 3 days prior and
> baby is on formula.  Mom needed a pump.  Baby and mom had all the classic
> symptoms of tt however, I could not see or feel anything. Baby also had
> significant postural preferences as well as asymmetry.  So I referred her
> for some body work which was delayed by illness of the provider.  We issued
> her a Lactina and teach hands-on technique.  One week later, her nipples
> are cracked and bleeding from the pump.  I provide smaller flanges,
> demonstrate hand expression, hand pump, discussed coconut oil / lanolin.
> Today she calls and schedules a follow up and lets me know everything we
> tried with the pump is still damaging her nipples.  Her breasts are full
> and she can't get the milk out.  I have encouraged hand expression however
> I don't think she is really trying it. I can swap the Lactina for a Hygeia
> which some moms have told me feels more gentle to them.
> 
> Baby got bodywork today and I heard from the therapist that the frenulum is
> now visible.  Baby will need a bit more however the therapist recommended
> possible revision prior to more work.
> 
> Of course this poor mom is so discouraged and in pain. She is wondering if
> she should just give up.  Besides hand expression what other options can I
> offer?  I welcome your thoughts and ideas!
> Thanks,
> Michele
> (who is having a rather odd mix of challenges today :-(  )
> 
> -- 
> *Michele L. Crockett, IBCLC, PCPA, LLLL*
> 
>     

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