Dear all:

If the card from Medela for sizing nipples for breast shields (flanges, cones, horns, or 
whatever else they are sometimes called) is the one I saw (and perhaps it is not), it may 
not work well.  I find I have to watch a mother pump for 5 minutes and sometimes longer 
to see what happens when the pump is turned on.

I have seen large fleshy nipples stay put and not rub or cause discomfort.  I have seen 
tiny nipples that are barely there expand out with the areola and turn into sausages in the 
pump with a huge amount of discomfort.  I have seen a B cup (while breastfeeding twins 
mom) who only had comfort with  a 36 mm breast shield.  The resting breast, areola, and 
nipple doesn't really reflect what happens when a pump is turned on.

Personally, I think the technology has a long way to go before it works well for the 
women who need to use pumps.  The mere shape of most breast shields is one I have 
never seen in women's breasts.  Our breasts are not conical and the sharp angle of the 
inner opening of most shields is often a place of intense friction.  I've seen mothers with 
larger breasts where the breasts fall out of the outer edges of the shield because the 
breasts just don't fit inside and then leakage occurs.  The softer shields may help 
pressure somewhat, or you can remove the inner petal from a certain brand of hand 
pump and use it on the shields for an electric pump, but neither of these will work if the 
opening is too small. There are angled shields that work better for some women because 
they have a grip pad underneath to keep milk from leaking out and three ridges on the 
upper part of the opening that distribute the pressure better, but these shields only come 
in one size so far.  Someday, I think they should really be "personal fit" by having 
something individually molded like mouth guards.  

And under any circumstances, moms should always know how to hand express.  Having 
lived through the big "Black out" followed by smaller black outs that were close to 
Manhattan in Queens --- one should always be prepared.  Sometimes, hand expression 
works a lot better for some women anyway!

Best, Susan Burger

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