Over the last few years I've had a few moms who just didn't pump well, if
at all, despite a good milk supply. I just had another one last night
(I'm so glad I do pump trials-- I'd hate to sell her an expensive double
pump and then have her come back saying she can't get any milk........).
Mom has approx. size D breasts, normal shape. Baby is one month old and
flourishing at breast.  We tried everything I had on her--- Lactina, PNS,
Elite, NurIII; with and without inserts, with flexishield (I keep hoping
these soft shields will milk better, but the moms uniformly complain of
pinching)........    The AE Elite system worked the best but was still
much less effective than it should have been.  I hand expressed on mom,
and found that her lactiferous sinuses were a bit farther back than
usual, though not *really* far.  Could easily squirt milk out of her, but
pump it? I've had a couple of these moms with largish, soft breasts and
sinuses placed back a bit, and they are tough to pump without lots of
manual breast compression--- double pumping is out.

I wish I had on hand an intermediate-sized flange to try.  The large
glass flange has never worked on any mother for me (though I didn't try
that one last night, didn't think of it until today); I'm wanting
something in between.

I've also had small breasted women with dense breast tissue (usually
Asian) whom the pump also did not get milk out of, despite successfully
nursing a baby.

What I need to know is this: how many of you have had these moms who just
"couldn't pump" with the usual good EBP systems, whether for extra large
nipples, unusally placed sinuses, dense breast tissue, whatever else?
How many have you seen, and how often?  Did you find ways to circumvent
the obstacles other than hand expression?

More importantly, did you wish you had another flange size/configuration
to try with her?  I'd like to collect your input and share it with the
pump companies, for the sake of these women who live on the outer edges
of the bell-shaped curve.

Lisa Marasco, BA, IBCLC