Kathy,

Have you tried using a smaller flange or tried pumping with a nipple shield
over mom's nipple to act as a splint?  We use a nipple shield sometimes to
prevent areolar/nipple swelling if a mom has very edematous breast with good
results. It may work in this mom's case too.

Linda Anderegg, BSN, RNC, IBCLC in Chicago, where I actually saw a robin
today after hearing its song this past week!

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Date: Mon, 9 Mar 2009 13:00:08 -0400

From: Katherine Lilleskov <[log in to unmask]>

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
extra 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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