Laurie, You asked about choosing pump flange sizes, and do we carry a tape measure and measure the nipple. Although I realize it is cheaper for the mother to be able to purchase only one size of pump flange if she needs a larger size than the standard one that comes in Medela's kits/pumps, it sure was easier for me when they originally sold them with both sizes (27mm and 30mm) in one package. Then if one size didn't work, the other size was already there. I work in private practice, not on a hospital floor, and the moms come to my office. So once Medela separated the sizes, and I had to choose the correct size, I did indeed start measuring. And discovered some interesting things. Some moms' nipples look "standard", but then widen up with pumping. Some widen up immediately, so mom knows right away that the sides of her nipples are scraping along the nipple shaft of the breastshield. Others don't widen up for three or four pumpings, and some don't widen up until mom's been pumping for 3-7 days! Also, some of the moms who experience pain and need a wider shaft don't actually have their nipples touching the shaft. Instead, the base of the nipple gets pinched right where the cone-shaped part of the breastshield narrows into the nipple shaft. So even though the nipple itself isn't scraping along the sides, mom needs more room so she doesn't get pinched where the nipple meets the areola. Medela has indeed come up with a tool that looks sort of like a 6-inch ruler, but has 4 different circles cut out. (Kind of like the spaghetti-serving measurers, but of course the holes are much smaller!) I brought one home from the conference in Amarillo in early June. It really doesn't need to be sterilizable, because you can hold it *close* to the nipple without actually touching it, and eyeball how the nipple looks through the cutout. And, yes, I have a stiff ruler with metric marking that I have been holding up in front of moms' nipples ever since Medela separated the two sizes of larger breastshields. Stiff ruler works much better than tape measures, because it holds itself out firmly. I've been measuring because I feel bad when I sell a mom one size, and she has to come back and buy another. But I've also learned to say to a mom, "This appears to be the size you need right now. But be aware that your nipple may widen [if I send her home with the 27mm] and you may need to come back and get the largest one in a few days." I can't just sell the largest size, because I've also learned that if you use one that's too big, there might not be a good seal, and then the mom won't get out much milk. (Ah, decisions, decisions!) I've also learned to look not just at the nipple itself when "eyeballing" for size. On many mothers, there is a faint circle around the base of the nipple. If you see that faint circle, be sure to measure (eyeball) around that, because the nipple often widens to the outer limits of that circle of tissue when mom pumps. If you don't include that circle of tissue in your measuring, then that mom is likely to come back complaining that she's feeling pinched at the base of the nipple. And remember, you always have to go a little bigger than what you're measuring. If a mom's nipples measure exactly 24 mm or 27 mm, you need to move up to the next size so there is space around the nipple in the shaft of the breastshield. If the nipple rubs along the shaft, the constant friction can lead to nasty abrasions, which can lead to infection (yeast or bacterial) because the integrity of the skin has been broken. I'm actually happy that Hollister/Ameda has brought out their larger breastshields (I think they call them flanges) with both sizes in one box. And, actually, I buy Medela's in bulk, rather than in the retail 2-pack packaging. That way I can sell a mom just one if she's using a single pump (manual or mini-electric). And I also had one mom whose nipples weren't the same size, and she needed one 27mm and one 30mm. If I had only had the 2-packs for sale, she would have had to buy 2 of each size, sort of like buying 2 pairs of shoes if your feet are different sizes. Because I buy in bulk, she was able to only spend the money on exactly what she needed. Hope this helps you decide what size shield to recommend to moms. Dee Dee Kassing, BS, MLS, IBCLC Collinsville, Illinois, in central USA *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html