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

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