I've found lanolin to be a horrible lubricant during pumping because it's so
tacky.  I suggest moms use a drop of olive oil around the edge of the barrel
for such purposes, and the feedback is very positive.  Extra light olive oil
is odorless.

When you say that nipple tissue just appears in the flange and rubs along
the side, are you saying that the nipple swells?  Moms with very soft
nipples can have this happen.  As Medela has explained, having the tissue
touch the sides of the barrel doesn't necessarily make it too small; it's
whether the tissue seems to get stuck in place in the barrel, like a cork,
that determines whether the larger size is better.  The nipple should extend
and retract with every suck, even after pumping for several minutes, not
getting stuck anywhere in the flange...but the barrel shouldn't be too large
either.  I've tried using a larger size flange on moms like this, and notice
that too much areola gets pulled into the flange, exacerbating the problem
and reducing the output even more.  You might be able to verify too large of
flange by watching for a ring to appear a few mm away from the base of the
nipple after pumping.  It's like the nipple will take up however much space
you give it because it's so soft.  Moms with this soft of tissue do really
well with manual expression -- have you tried that?  It would also help you
find the "sweet spot" on mom's areola for getting the milk out, to best
position baby for latch.

BTW I agree about needing a 33mm flange.

Debbie Gillespie, IBCLC, LLLL
Tempe, AZ


On Mon, Mar 9, 2009 at 10:00 AM, Katherine Lilleskov
<[log in to unmask]>wrote:

> I am working with a mom whose baby is only able to extract about 1 to 1.5
> oz
> at the breast before getting worn out and falling asleep. I believe this
> baby
> might have a type 4 TT but mom is adamant that she will wean before she
> will
> let baby have tongue clipped. The baby's latch is quite tolerable for her,
> sometimes painless and sometimes mildly painful, but pumping is
> excruciating.
> She is pumping with a pump in style to maintain her supply, but finds that
> no
> matter what size pump shield she uses it is painful.The hospital grade pump
> was no better. We have gone up to a size 30mm. I honestly don't think she
> is
> a candidate for a size 36 - certainly her measurable nipple tissue is not
> that
> large.The suction is set at the lowest setting and we have attempted
> lubricating with lanolin. Her nipples are unusual in that when you look at
> them
> they appear  standard size and everted but when she pumps it seems like
> nipple tissue just appears in the flange and rubs along the side, almost
> like she
> has stealth nipple tissue that you don't see unless the nipple is tugged
> on. Or
> maybe what we are seeing is actually areolar tissue, but you can't tell
> where
> nipple ends and areola begins....As soon as she stops pumping the nipple
> retracts to it's prepumping shape and looks like an ordinary everted
> nipple. I
> suspect that this might be making it harder for the baby to extract milk as
> well
> and am hoping that as the baby's mouth grows his suck will improve. I
> suggested an exta large pumpin pal,which hasn't arrive yet, but other than
> that am out of suggestions. Why doesn't medela make a size 33mm???And
> even if they did, I don't know if this is a size thing or just the
> discomfort of
> the mechanical pulling on her nipple.Talking her into a frenotomy is out of
> the
> picture, so I am wondering if anyone has any suggestions to make pumping
> more tolerable. I had this situation before with another woman who had
> completely normal looking nipples, they didn't even rub against the flange
> or
> anything,painless nursing, and we were completely unable to get pumping to
> feel tolerable - tried everything we could. Is this caused by adhesions on
> the
> nipple - what is it????? Thanks for any answers to this mystery.
> Kathy Lilleskov RN IBCLC
>
>             ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: set
> lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet welcome
>

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome