In a message dated 96-12-22 10:45:38 EST, you write:

>From:    April Tutino <[log in to unmask]>
>Subject: Huge Nipples-Help Needed Urgently!
> have a mom with L cup breasts and nipples that barely fit in baby's mouth.
 Areolas are about 6" diameter.

April, My heart goes out to this mom.  I don't wont speculate on how long it
may take, but in Marmet 5-3 (Lactation Forms), Lawrence and I believe I've
read in Auerbach that sometimes we have to support the milk supply with
expression while we wait for the baby to grow.  I have had several mothers
with large nipples that had difficulty pumping due to the size of the flange.
 The first mom I encountered with this size areolae and nipples really didn't
want to put the baby to breast,  she only wanted to express for the baby.  A
few others who have been successful at getting the babies on the breast still
had difficulties with pumping.  Each had success with the Large glass shield
that inserts into the standard flange .  Used to be able to get them from
Egnell but now are only available from Medela.  They are quite expensive but
are WELL WORTH the cost.  I keep several in my practice and rent them out as
needed.   According to Chele Marmet, if the nipple is wider than 3/4" the
large glass shield will be beneficial.
Hope this helps.  You may E-mail me privately.  I have long felt that some of
the moms who have difficulty pumping and give up fit into this category.
 This is one of my pet-peaves with pharmacies and med supply houses renting
pumps.  They don't have the benefit of assisting the mother with the first
pumping to assure that the pump works for THIS mom....Soap box closed. Liz
Flight in sunny but chilly Jacksonville Florida.