Hello, JP.
       You want to know when moms use the breast insert.  Back when Medela
included the standard flange and the small insert in their pump kits, I always
told moms to try it both ways.  For some moms, only one size was comfortable.
But for those who could use it with or without the insert comfortably, some
found that pumping 5 minutes with the insert removed and 5 minutes with the
insert in place put different pressure on the ductwork, and they got more milk out
in the same 10 minutes of pumping than when they only used one size.  Some
moms needed to start with the insert removed, and some needed to start with the
insert in place.
       As for the petal flanges, again it varies from mother to mother.
While most moms love the petals on the Avent (we don't have White River around
here) and do quite well with the silicone insert, some mothers have done better
removing the silicone insert and just pumping with the hard
breastshield/flange.
       As with so many things about breastfeeding, pumping is trial and
error.  Some moms respond better to one brand than another, to manual rather than
electric, to different sizes and types of flanges.  Although it would make it
easier for us breastfeeding support folks, there just isn't one rule that fits
all!  :)
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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