There may be several things involved in a mom who will not let down to a
pump.  Once the let down occurs, she should get plenty of milk if baby is
growing well.

The most likely scenario is that the pump is not fitted properly.  If you
can use hand expression to determine where the best spot is to get out milk
with your fingers, try to find a flange that matches that spot.  With this
you are looking at the inside diameter of the flange, not the outside edge.

Another possibility is that she needs a different type of cycling than she
has been getting from the pumps she has tried.  Some moms need very quick on
and off, others need a short off and a long on cycle.  Pumps have different
curves that can greatly affect milk production.

Having baby nurse on one side and pumping the other is an excellent strategy
to help with conditioning mom to let down to the pump.

A few years ago, I had a mom who would not let down to any pump we had.  It
was shortly before the variable speed Lactinas became available.  We tried
everything and nothing worked.  When we put a pump to her breast she would
not even let down for baby!  Mom was feeling very bad about leaving baby to
return to work.  A few months later, Medela released the Lactina Select and
I asked her to come back and try it to see if it would work for her.  It
worked beautifully as did every other pump we had.  What was the difference?
She found a way to work and not leave baby.  Mom had it so firmly engrained
in her mind that if she made milk for a pump that she would have to leave
baby that she would not let down to the pump.  Once she found a way to keep
baby with her, she no longer felt her relationship with baby threatened by
the pump and there was no more problem.

Good luck with this mom.

llp

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