I have a few thoughts on Nancy's case:
1.) When possible prenatally, I think it helps a lot to "evert" the nipples.
The ability to gradually work up the elasticity of the adhesions between the
nipple and the base of the nipple really reduces the pain post-birth when
trying to stimulate milk production.
2.) Get an effective hospital-grade electric breastpump.  The one you're
using is not effective enough for exclusive pumping and for initiating a milk
supply.
3.) Start galactogogues for this mom.  Don't waste any time as we know the
first 2 weeks after birth are when the prolactin receptors are most viable.
After 2 weeks they involute and though still possible to stimulate, it is more
difficult.
4.) Use the nipple ring to maintain the nipple in an everted state so that
the moisture can dry and promote healing.
5.) Use Jack's all purpose nipple ointment to promote healing.
6.)Continue air drying after pumpings with nipple ring worn.
7.)Painful to pump?  I think this is partially caused by the type of pump
being used and if still painful with a more effective pump, then I'd use the
nipple everter with this mom as then she can work on those adhesions with less
discomfort.
8.) Ibuprofen as needed for pain relief.
Just some of my thoughts.....
Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL

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