I'm reading your messages closely because I have also received similar calls and have not really found I knew THE correct answer...  Of course, we know that the correct answer is based on finding the correct problem...so maybe we need to concentrate on creating a list of all the reasons for this problem, so we can try to identify the cause when we see a mom.  

The more we think and talk about issues...the more we learn - that is the Value of Lactnet for me!

I've recommended many of the options previously mentioned: massage prior to pumping, hands-on pumping, hand expressing after pumping, cluster pumping, pumping while baby is at the breast, getting their bodies used to a "trigger" (glass of water, smell, music) whenever breastfeeding and then using them when pumping, etc.

Some other options that have worked with some women:
 - a different flange, even when the flanges they were using "looked" fine...  One mom's breasts looked very similar, but one breast released milk, the other didn't - so we tried the "huge" glass flange from Medela (this was over 15 years ago) and it worked!
 - changing flanges during the pumping
 - not pumping for more than a few minutes when no milk comes out (Stop, massage, try hands-on pumping and if that does not initiate milk release - take a break and pump later) ...but trying to pump at least 120 minutes in 24 hours (a number mentioned in a JHL article I read a long time ago, but gives mom a goal) if baby is not nursing at all.
 - Try to pump at least 5 times a day (I loved the idea of putting 5 cheerios or 5 candies to "reward and remind" mom to pump) if baby does breastfeed - again, only as long as milk flows, then massage, try hands-on pumping and if that does not initiate milk release - take a break and pump later.
 
Wish I could say any of these were THE cure...but no, they have not always been.  Will be glad to see other suggestions...

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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