Dear all and Lee:

It is always impossible to really read intentions, but my suspicion is that Medela is 
providing the promotional parts to PROMOTE their products.  I cannot see any benefit to 
them giving out promotional samples that cause harm.  That would be completely 
counterproductive.  What I think about the promotional products is that they are 
considered STARTER products as they or maybe others have named the STARTER SNS. I 
think these are considered what you get in the hospital and then you can get more of 
what you need once you are out of the hospital.

Five years ago I started watching any woman I visited who was already pumping when 
she pumped.  It was quite revealing.  I found many women had pain because the shields 
were ill fitted.  I think the reason why there is pain with those shields is based on the 
false notion that you fit shields to the size of the nipple.  It has zero to do with nipple 
size.  I've seen tiny stretchy nipples expand out to plug up the shields and tough thick 
nipples not touch the sides at all.  I think Medela generally makes its shields too small 
and the soft cups don't always compensate.  I've only seen the soft cups in their regular 
size and they can sometimes rub as much or more on certain types of areola tissue.

What I think is the real problems are:

a) the links between the hospital and knowledgeable follow-up outside the hospital are 
very weak because only 3% (last time I looked) of IBCLCs are in private practice.  
Therefore, mothers don't know that the starter SNS clogs up with time and that there is 
not one, but many alternatives to what is a temporary device. 

b) the products are probably not tested with large enough samples sizes or possible with 
a narrow range of women who are not having problems.  Hence the problems crop up 
after the product is distributed.  

The combination of a) and b) leads to situations where no one notices that the slightly 
smaller shields and tubes are making a difference in women who really need some 
mechanism to release milk.  Or, the FreeStyle pump not cutting the mustard for a fair 
proportion of these women. 

I generally have problems with promotional samples because customers ultimately pay 
for them and in the hospital setting these products are not selected on the basis of what 
works best in a competitive manner, they are selected based on the relationship with the 
company.  I really don't care what type of equipment or drugs one is considering --- this 
creates monopolies which are not good for product development --- and creates markets 
for products that may not always be needed.  Look at the lanolin ointments, have you 
met many mothers that haven't already bought it before the baby is born? 

Best, Susan

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