Dear all:

The 2-1/2 oz per pound per day rule does not last.  Babies plateau at about 25-35 ounces per day somewhere around about 6 weeks to 6 months.  Nancy Morbacher's Breastfeeding Answers Made Simple has excellent references and more precise citations for this GENERAL rule of thumb.  If you take a 20 pound baby using the 2-1/2 oz per pound rule then you would be overstuffing that baby with 50 oz per day and creating an overweight baby.  I know many mothers who continue the rule of thumb and are literally stuffing their babies or freaking out because their milk supply doesn't keep increasing.

As for flange sizes, I think it is very instructive to WATCH women pump.  This taught me so much about what is uncomfortable.  The SIZE of the nipple in its resting state is MEANINGLESS.  It is what happens when you turn the pump on and how a mother feels.  Most mothers feel more discomfort when more skin rubs against the plastic, but a tiny minority of women actually feel better when there is a tighter fit.  Without seeing what happens to this mothers nipples, I would not attempt to guess what size works for her.  I once worked with a mother of twins whose breasts probably were much larger than 36 mm -- yes breasts not nipples, but that worked for her and she yielded plenty of milk.  Olive oil can really help with rubbing.  And the angled shields help with other women.  Jaye Simpson and I for whatever reasons have exactly the OPPOSITE experiences with the angled shields.  I find they work better with women with larger more elastic breasts than firm breasts and she finds the opposite. I've never been able to figure out why -- but perhaps someday we should seek permission and skype our clients so we can see why we get opposite results.

And some women just never react well to plastic rubbing against their skin.

Best, Susan Burger

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