In a message dated 5/23/04 11:52:12 AM Eastern Daylight Time, Lynn Shea
[log in to unmask] writes:
What percentage of women that you "see", do you find need a size other than
standard?
Lynn, thanks for the dialogue.  This is something that I have become very
passionate about because I work with so many women who rely on their pumps to
maintain their milk supply.  I think this problem is more prevalent that most
people think.  Although there are women who "fit" the standard shield, there are
others who would benefit from changing one or both of their shields to a size
that would provide optimal emptying.  I think Medela should have a warning
label similar to the box on cigarette packages.  It should say something about
the breastshield being available in three other sizes.  Most women try to fit
round pegs into smaller holes without realizing they have other options.

    Your question about the Isis-- I love it as long as the woman fits it.
If her nipple is too large or too small for the flange, it will not be as
effective for her to use it.  I love the tulip nature of the shield, and wish they
would make different size shields, and even try a hand at double electric pu
mps.


ALSO Lynn writes:  "I'm confused here.....are you suggesting that "without
complete or optimal breast emptying "that this Mom would have developed
mastitis? Please clarify."


Yes. that is exactly what I am suggesting.  Also, some women have nipples
that swell during this engorgement period ONLY.  When the nipples are swollen,
using a regular shield may actually constrict emptying.  Temporarily moving to a
larger size helps to alleviate the engorgement at a faster rate (this is only
if the nipples have swelled to a larger size--if the breast can swell, so can
the nipple!)  Once swelling dissipates, mom can use a smaller shield again.
When someone still feels full pumping after pumping--the larger shield size
issue should come to mind.  Since mom could have had larger nipples in the first
place, don't assume that it will be temporary until the engorgement is gone,
and you can see what you are really dealing with.

Just one comment to add.  I call this the "Vanna syndrome"-- I have some
ladies who just can't believe that they need a larger shield.  It is like telling
her that she has gone up a dress size.  The reaction is usually pretty much
like, "No, I think these shields are fine.  Is there anything I can take to
increase my supply?"  Unfortunately, this often leads to nipple torture and
reduced milk supply.  Don't ask me why, but just like trying to squeeze into the
dress that doesn't fit, this mother will keep squeezing her nipple into the wrong
shield.  Usually, however, if she continues to have pain/supply problems, she
will figure it out.


Debbie Albert, Ph.D., IBCLC, soon to be RN!
Tampa Lactation Counseling
Tampa, FL

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