Carol said:
the second mother was also immediately rented a pump, a necessity in this
case, but was not given the larger cups that seemed obviously needed due to
her large breast size.

Sylvia said:
I am wondering how many of you folks run into a situation where the standard
breast flange is too small to properly pump a mom?   I know that one of the
large companies makes a large glass flange.  The price each  is $43  &
suggested retail of $78.

Carol and Sylvia,
It might not be so obvious.  The size of the cups/breast shields that come
with the various breastpumps have nothing to do with breast size.  It is the
mother's nipple size that matters.  In the past 12 years that I have worked
with mothers & pumps there have only been 2 of the thousands I have seen who
needed the special hand blown glass extra large breast shields.  Both had
nipples that were over 1  1/2 inch in diameter!!!  Many women with HUGE
breasts have little tiny nipples and even need to use the inserts provided
with good pumps to prevent nipple tissue damage.  Others with little tiny
breasts can have HUGE nipples that are both wide and long.  This should be
part of our breast/nipple assessment for breastfeeding.  I do agree that many
people assisting and counseling mothers don't have enough experience, and
have not seen enough breasts and nipples to realize the implications of
various types and sizes for breastfeeding or pumping.

A good thing to do is to compare it to fitting a pair of shoes. A huge person
can have little feet and vice versa.  Also it is important the shoes are not
too big, or they will cause blisters, or too small or they will pinch.

The mothers I have seen that have extra-extra large nipples will blanch and
pinch when they try to pump and the breast pump flange is too tight.  Also
very little or no milk will come out as the pump is simple pinching the
nipple shut.  Hand expression works well though, proving that the milk is
there. For the mothers who need them the XL hand blown glass breast shields
are a life saver and well worth the expense.  One things some LCs do is to
"rent" the glass breastshield to the mom, with an initial deposit equal at
least to the cost, so that if it breaks, it belongs to the mom, but if it
doesn't she can return it and pay whatever rent you ask. (say $10/month I was
thinking of--just a suggestion)  Since they are glass they are easy to clean,
steralize, and reuse safely with other moms if the mother does not want to
purchase it.

I'm interested in what other experienced people have to say about this too.

This is my experience and I hope this helps.

Jane Bradshaw RN, BSN, IBCLC
Lynchburg, VA