Hi All!

I'd like to ask for your collective experience regarding the above. 

So far in my new practice I've seen 3 mothers with sore nipples and the 
only reason I could find was a flange that was too small. 

All 3 had larger than average nipples and were sent home from the hospital 
with the standard 24 mm flange.

All 3 were exclusively pumping for various reasons and pumping was 
exquisitely painful right from the start. They thought that is how it was 
supposed to be. 

Two of the moms ended up with mastitis. One persevered through severe, 
prolonged engorgement, the painful pumping resolved when she switched to a 
30 mm flange. She is now breastfeeding exclusively.

The 2nd mom was supplementing more and more so she didn't have to pump. 

The 3rd mom is ready to stop breastfeeding any day now. Her pain is 
unchanged with larger flanges, she is on Clindamycin for mastitis. I amd 
not suspecting a yeast infection because the baby wasn't suckling and does 
not have thrush. Mom did receive proph antibiotics for her c-secn.
She has been pumping every 2-3 hrs inspite of the pain but only manages to 
get 1-2 oz each time. The milk does not flow/spray, it mostly just drips. 
Her breasts are somewaht swollen, very lumpy and moderately tender. She is 
also on fenugreek. 

Please advice regarding mom#3. IS there anything I am missing?

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