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Subject:
From:
Katherine Lilleskov <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 9 Mar 2009 13:00:08 -0400
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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 exta 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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