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Subject:
From:
Dee Kassing BS MLS IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 30 Jun 2003 10:01:39 EDT
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Laurie,
       You asked about choosing pump flange sizes, and do we carry a tape
measure and measure the nipple.
       Although I realize it is cheaper for the mother to be able to purchase
only one size of pump flange if she needs a larger size than the standard one
that comes in Medela's kits/pumps, it sure was easier for me when they
originally sold them with both sizes (27mm and 30mm) in one package.  Then if one
size didn't work, the other size was already there.
       I work in private practice, not on a hospital floor, and the moms come
to my office.  So once Medela separated the sizes, and I had to choose the
correct size, I did indeed start measuring.  And discovered some interesting
things.  Some moms' nipples look "standard", but then widen up with pumping.
Some widen up immediately, so mom knows right away that the sides of her nipples
are scraping along the nipple shaft of the breastshield.  Others don't widen
up for three or four pumpings, and some don't widen up until mom's been pumping
for 3-7 days!
       Also, some of the moms who experience pain and need a wider shaft
don't actually have their nipples touching the shaft.  Instead, the base of the
nipple gets pinched right where the cone-shaped part of the breastshield narrows
into the nipple shaft.  So even though the nipple itself isn't scraping along
the sides, mom needs more room so she doesn't get pinched where the nipple
meets the areola.
       Medela has indeed come up with a tool that looks sort of like a 6-inch
ruler, but has 4 different circles cut out.  (Kind of like the
spaghetti-serving measurers, but of course the holes are much smaller!)  I brought one home
from the conference in Amarillo in early June.  It really doesn't need to be
sterilizable, because you can hold it *close* to the nipple without actually
touching it, and eyeball how the nipple looks through the cutout.  And, yes, I
have a stiff ruler with metric marking that I have been holding up in front of
moms' nipples ever since Medela separated the two sizes of larger
breastshields.  Stiff ruler works much better than tape measures, because it holds itself
out firmly.  I've been measuring because I feel bad when I sell a mom one
size, and she has to come back and buy another.  But I've also learned to say to a
mom, "This appears to be the size you need right now.  But be aware that your
nipple may widen [if I send her home with the 27mm] and you may need to come
back and get the largest one in a few days."  I can't just sell the largest
size, because I've also learned that if you use one that's too big, there might
not be a good seal, and then the mom won't get out much milk. (Ah, decisions,
decisions!)
       I've also learned to look not just at the nipple itself when
"eyeballing" for size.  On many mothers, there is a faint circle around the base of the
nipple.  If you see that faint circle, be sure to measure (eyeball) around
that, because the nipple often widens to the outer limits of that circle of
tissue when mom pumps.  If you don't include that circle of tissue in your
measuring, then that mom is likely to come back complaining that she's feeling
pinched at the base of the nipple.
       And remember, you always have to go a little bigger than what you're
measuring.  If a mom's nipples measure exactly 24 mm or 27 mm, you need to move
up to the next size so there is space around the nipple in the shaft of the
breastshield.  If the nipple rubs along the shaft, the constant friction can
lead to nasty abrasions, which can lead to infection (yeast or bacterial)
because the integrity of the skin has been broken.
       I'm actually happy that Hollister/Ameda has brought out their larger
breastshields (I think they call them flanges) with both sizes in one box.
And, actually, I buy Medela's in bulk, rather than in the retail 2-pack
packaging.  That way I can sell a mom just one if she's using a single pump (manual or
mini-electric).  And I also had one mom whose nipples weren't the same size,
and she needed one 27mm and one 30mm.  If I had only had the 2-packs for sale,
she would have had to buy 2 of each size, sort of like buying 2 pairs of shoes
if your feet are different sizes.  Because I buy in bulk, she was able to
only spend the money on exactly what she needed.
       Hope this helps you decide what size shield to recommend to moms.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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