Anne,

I am wondering just what this statement might mean <since mom's breasts don't respond well to the pump.>


Nipples, and the delicate base of the nipples can become very painful if the pump flange tunnel is not large enough to admit some of the areola (IME a radius of 1 cm. or more, in some women even 2 c.m. ). Too small a flange may also yield a restricted flow of milk. What size flanges have you tried? Have you tried different sizes on opposite breasts at the same time? What degree of vacuum is being used??


Nipple pain can be eased either by a covered ice pack for 5-10 minutes to numb it, or alternatively and perhaps more comfortably, by a folded washcloth saturated with the warmest water the mother can comfortably stand on her wrist. Apply the pack to the entire areola and nipple till it cools off. One radiology book states that radiologists use this method if necessary for comfortably relaxing the internal muscles of the nipple before ductal catheterization for dye injection for radiology exam of the ducts.


If MER to the pump seems to be a problem, I suggest you show her how to trigger it by applying reverse pressures softening (RPS) for 20-30 seconds and wait one minute before starting to pump. If the flow slows after 5-7 minutes, suggest a pumping pause for forward massage or breast compression to manually push more milk forward, then encourage her to apply RPS again to trigger another MER. This may be repeated at intervals of slowed flow as often as necessary, and may result in more milk in a shorter actual pumping time. 


If you have not already done so, I encourage you to try various sizes of flange tunnels for a long enough time to find if more efficiency and less trauma to the internal tissues of the nipple may result. The most effective size may be different for each breast. The internal anatomy may have developed somewhat differently in each breast, with the galactophores on one side having a deeper junction with the subareolar ducts.


An adequate size flange tunnel ensures that there is no skin schear or torsion on the nerves and blood and lymphatic vessels of the nipple or the delicate tissues of the nipple base itself. It also allows the areola and its subareolar ducts to respond efficiently to external pressures in order to push comfortably forward into the tunnel. 


A properly sized flange allows a sufficient length of the full subareolar ducts to enter the tunnel to compress themselves against it's sides. This raises hydraulic pressure in that area of those ducts sufficiently to propel a better volume of milk forward through the tiny galactophores each cycle.  Don't believe anyone who tells you that vacuum "pulls the milk". It is the raised hydraulic pressure generated by compression on the ducts that neutralizes the vacuum each cycle, because nature abhors a vacuum.


It will be interesting to find if any of this helps lessen one or more possible components of nipple pain and improve "the response of her breasts to the pump.".


K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC, Dayton OH

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