Hi Lynnette,

 Thanks for your post.  I know it is hard when you are starting out to find answers to all the questions that every newbie has.

I have some thoughts about your choice of flanges.  You state that the mother's nipples are small (small in diameter?) and short.  Your choice of the 30mm, then the glass flanges and finally the 24mm flanges is the reverse order that I usually take.   I watch the mother closely when she pumps.  Occasionally I have been fooled in the past and I thought that the mother's nipple had widened, when in reality her areola was sucking into the tunnel of the flange.  These mothers actually need the 21mm size flange.  I find many mothers need the 27 and the 30 mm flanges to accomodate their wider nipples.  I recommend the glass flanges to the uncommon mom with extremely wide nipples.  I would reccommend that you read The Breastfeeding Atlas which has an excellant discussion about sizing  flanges and  nipple shields.  I have really learned a lot from this book.

I have watched many mothers, with low milk supply, drip and squirt in the manner that you mentioned.  They are having multiple "let-downs" but there isn't much milk to let-down.  

Mother's swollen and sore right breast probably had plugged ducts from the 3+ days where she did no breastfeeding or pumping.  These plugged areas will further down regulate her supply.

I rarely use a 16mm nipple shield.  The mother truly has to have a tiny nipple to comfortably use it.  If you "stuff" a nipple in a too-small nipple shield it compresses the ducts  and may completely occlude them.  5 pound babies can comfortbly use a 20 mm nipple shield.  By your description, I would not have recommended that you use a nipple shield.  This baby would probably be a good little breastfeeder if there was some more milk to drink.  You did not mention  the baby's birth weight.  Perhaps on your next update, you could also tell us if the mother used fertility drugs or in vitro fertilization to conceive.  Sincerely, Rachel Wahl  

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