Medela pumps (and many other brands) come with an optional part that fits inside
the flange called a breast shield insert.  It narrows the inner diameter of the
flange.  This is used to adjust the pump to the size needed as determined by the
diameter of the mom's nipple.  If she is using the wrong size she may be causing
trauma which results in swelling.   I have seen a few nipples greatly swollen
after pumping.   Many moms mistakenly think this part is meant to adjust for the
size of the breast instead of the size of the nipple.

The pump flange is too tight if the side of the nipple rubs on the flange.   If
using the insert then remove it.  If it is still too tight without the insert
Medela has a special flange that can be purchased with larger inner diameter.   It
used to be there was just a hand blown glass one, but now there is a new plastic
one.

The pump flange is too loose if there is a puffy ring of areolar tissue around the
base of the nipple.   Adjust by using  the optional piece.

She should also be sure the nipple is well centered in the flange.

Sometimes the pressure is too high, or too high too quickly, if so adjust
accordingly.

Sometimes lubrication on the nipple/areola  with something like olive oil helps
things to glide more easily and there is less trauma.

Even when starting with a reliable product sometimes a different pump will not
cause the same problems.   Flange sizes have some variety.   Rental pumps are
different from purchase pumps in that they cycle and release more quickly, this
causes less trauma.   White River has a pump that uses  compression over the
areola, Medela and Hollister both have special parts that also attempt to do this
- perhaps this different mechanism would work with less trauma.  Hollister/Ameda
Egnel has a pump with adjustable  rates for the suction release.  I'm sure there
is even more variety out there, these are just the ones I'm familiar with.

Hand expression is an option.  If done properly it causes no trauma to the
nipple.  Good information on the technique can be found at
http://www.lalecheleague.org/NB/NBMarApr96.work.html    or
http://www.parentingweb.com/lounge/hand_express.htm
The Medela web site used to have an illustrated instruction guide to the Marmet
technique but I can't get it up now.  Does anyone know where it went?   It can
also be found in their printed Breastfeeding Information Guide and I believe on
the back of the tear sheet for engorgement.

If the swelling doesn't hurt mom perhaps she could still pump 3- 4 hours into the
early part of her workday and it might be down by the time she is ready to reunite
with baby but I worry about what damage might be happening anyway.


>
> Mom states her nipple is bigger for some time after pumping and thinks this
> bothers the baby. She is using a Medela single electric.
> My thought is she could adjust the suction on the pump but why the odd
> shaped nipple and baby's refusal to nurse?

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html