It would not hurt to do a trial with another style or type of pump 
(Symphony or Classic). I would recommend that someone check her pump 
with vacuum gauges and make sure it is working properly. These are 
available from the pump manufacturer. Ideally, rental pumps are checked 
each time they are returned to the pump depot. Pump manufacturers give 
the ranges of adequate suction for their pumps.  The other important 
thing is that her flanges are big enough, which you said she is using 
already.  Make sure she is taking the right doses of domperidone, 
fenugreek and blessed thistle.

As an aside, I find in my practice that when moms have a rough birth and 
get started pumping late or not enough times in 24 hours, they often do 
not do as well as those that start on day one or two and do 8 times in 
24 hours.

It is always worth a try to change to another style of pump. The mothers 
that I work with generally do not do well on the Symphony in the 
hospital (meaning getting nothing or just drops on day 3-4 but ounces 
the first time we have them use another pump loaned by our WIC agency). 
It could be that no one shows them how to use the Symphony pump 
properly. Some of my mothers crank up the suction really high to 
compensate for getting no milk out. Or it could be that I am the first 
to give them large enough flanges.

Kathy Eng, BSW, IBCLC

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