Ilene, Your client certainly has her work cut out for her! Would that there were some way to simplify it for her so that she and her babies can enjoy breastfeeding, and soon. Does your WIC clinic have a private office where you could offer to check this mom's milk reservoirs? Their placement differs in different moms, and sometimes even in the 2 breasts of the same mom. This is partly determined by the process of nippleareolar development and the pattern with which connective tissue proliferates within that area. It may be that the standard pump flange is not right for this mom. Perhaps hand expression would be more effective, even if more time consuming. Perhaps the LLL handout on the Marmet method for her to read and try might be helpful, especially the part about massage. Making sure the MER is triggered first before pumping or hand expression also yields more milk faster. I once saw a mom with very large nipples where the reservoirs were IN the nipple itself. In thousands of nipple assessments over the years, this was the only time I ever saw such placement. In retrospect, I rather doubt that a standard pump would have worked for her. E-mail me privately if you have questions. K. Jean Cotterman RNC, IBCLC Dayton, Ohio ___________________________________________________________________ You don't need to buy Internet access to use free Internet e-mail. Get completely free e-mail from Juno at http://www.juno.com/getjuno.html or call Juno at (800) 654-JUNO [654-5866]