I agree with Susan's suggestions. Has she tried a different size flange? I would also ask the Mother if she is turning the pump on first then placing the flanges on the breast. This could add more trauma as she attempts to adjust the flanges once on the breast. She may want to consider a compression pump such as the Limerick PJ Comfort- it has a different action (compression) rather than suction and may give her the relief she is looking for. 
Beverly 

> On Jan 24, 2015, at 3:49 PM, Susan Lawrence <[log in to unmask]> wrote:
> 
> Rachel,  I've seen some different situations that sound like you describe.
> 
> Maybe the nipple faces or around the edge of the nipple face look almost
> like mulberries or raspberries ?
> 
> Sometimes it's just too much vacuum from the pump, such as the vacuum
> setting too high or prolonged/ infrequent suction cycling on some cheaper
> automatic pumps or ones that require the mother to release the suction each
> cycle- -or any specific pump's wave form not being a good match for that
> particular mother, no matter how expensive or well-marketed:) And maybe it
> used to be ok but now the suction has become out of whack (technical term).
> 
> Ideas: turn down the suction, lubricating the inside of the flange with
> edible (olive, coconut oil, etc-I'm less of a fan for lanolin for pumping
> lube) making sure there isn't tubing from one manufacturer on another's
> pump (really can change the pressure dynamics sometimes),
> cleaning/replacing the white flap on the Medela or the white valve on the
> Ameda kit, trying Pumpin Pals.   Stanford hands-on pumping video. I think
> you're on the right track with using more hand expression, etc. Maybe
> fennel, relaxation/visualization/music for MER?
> 
> I've also seen those berry nipple faces on women who had some aspect of
> nipple inversion, sometimes even a previously unrecognized dimple, and once
> it's everted with suction that nipple face skin can end up with some of the
> berry look . That she'd been using a shield initially might be a hint on
> nipples not being totally everted to begin with (at least it would be in my
> area). I gather her nipples have never been comfortable with baby or
> pumping.
> But same ideas you're doing to get milk expression more gentle apply.
> 
> At a conference last year, Hale was discussing (in terms of
> pharmacokinetics)  that most women don't continue to make as much milk
> after 6 months as they did the first half of the baby's year and that that
> later milk production is often overestimated by mothers. So maybe that
> would be of comfort for her to hear, if her baby has started other foods.
> 
> Susan Lawrence, Berkeley, California (no connection to any of the above
> products)
> 
> 
> Subject:
> I have had email and phone contact with a mother who began pumping at two
> weeks when her son was unable to attach without nipple trauma for her and
> great unhappiness for him. She got blisters during a short attempt with
> shields. There is no local help easily available for her. She is extremely
> motivated and only gets in touch when at her wit's end.
> She has now been pumping for 7.5 months, but we've not been in touch since
> the fall when I advised her to seek medical attention for the skin damage.
> Her GP did cultures for bacteria and yeast, all negative. Recently her
> nipples have started looking more damaged, like blood blisters around the
> tips, with almost raw-appearing spots at the very tips. They look their
> worst just after pumping, but never look normal. She reports it now takes
> longer to elicit the MER than previously and I suspect the prolonged vacuum
> from the pump on her skin to be the cause. Have suggested she hand express
> at least to MER before applying pump, if at all. She is concerned her
> supply will be irreparably reduced if she stops pumping and she doesn't
> want that. I've not seen anything like it before.
> Please post if you have experience with pump-related nipple trauma. I can
> send pictures privately if need be.
> Rachel Myr, Kristiansand, Norway
> 
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