Rachel,  I've seen some different situations that sound like you describe.

Maybe the nipple faces or around the edge of the nipple face look almost
like mulberries or raspberries ?

Sometimes it's just too much vacuum from the pump, such as the vacuum
setting too high or prolonged/ infrequent suction cycling on some cheaper
automatic pumps or ones that require the mother to release the suction each
cycle- -or any specific pump's wave form not being a good match for that
particular mother, no matter how expensive or well-marketed:) And maybe it
used to be ok but now the suction has become out of whack (technical term).

Ideas: turn down the suction, lubricating the inside of the flange with
edible (olive, coconut oil, etc-I'm less of a fan for lanolin for pumping
lube) making sure there isn't tubing from one manufacturer on another's
pump (really can change the pressure dynamics sometimes),
cleaning/replacing the white flap on the Medela or the white valve on the
Ameda kit, trying Pumpin Pals.   Stanford hands-on pumping video. I think
you're on the right track with using more hand expression, etc. Maybe
fennel, relaxation/visualization/music for MER?

I've also seen those berry nipple faces on women who had some aspect of
nipple inversion, sometimes even a previously unrecognized dimple, and once
it's everted with suction that nipple face skin can end up with some of the
berry look . That she'd been using a shield initially might be a hint on
nipples not being totally everted to begin with (at least it would be in my
area). I gather her nipples have never been comfortable with baby or
pumping.
But same ideas you're doing to get milk expression more gentle apply.

At a conference last year, Hale was discussing (in terms of
pharmacokinetics)  that most women don't continue to make as much milk
after 6 months as they did the first half of the baby's year and that that
later milk production is often overestimated by mothers. So maybe that
would be of comfort for her to hear, if her baby has started other foods.

Susan Lawrence, Berkeley, California (no connection to any of the above
products)


Subject:
I have had email and phone contact with a mother who began pumping at two
weeks when her son was unable to attach without nipple trauma for her and
great unhappiness for him. She got blisters during a short attempt with
shields. There is no local help easily available for her. She is extremely
motivated and only gets in touch when at her wit's end.
She has now been pumping for 7.5 months, but we've not been in touch since
the fall when I advised her to seek medical attention for the skin damage.
Her GP did cultures for bacteria and yeast, all negative. Recently her
nipples have started looking more damaged, like blood blisters around the
tips, with almost raw-appearing spots at the very tips. They look their
worst just after pumping, but never look normal. She reports it now takes
longer to elicit the MER than previously and I suspect the prolonged vacuum
from the pump on her skin to be the cause. Have suggested she hand express
at least to MER before applying pump, if at all. She is concerned her
supply will be irreparably reduced if she stops pumping and she doesn't
want that. I've not seen anything like it before.
Please post if you have experience with pump-related nipple trauma. I can
send pictures privately if need be.
Rachel Myr, Kristiansand, Norway

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