Someone mentioned that a mom using the (I assume Medela kit) flanges used only the outer flange and not the insert, and it didn't seem to matter that the nipple seemed a better fit for the insert. I hope I am remembering this right. Someone else said she noticed most moms use only the outer shield too. I have noted this too. Now my question is this: How exactly do you LCs go about deciding what flange to use? Do you measure anything, or eyeball it, and if so what are you looking for.? I must admit that I am not doing anything scientific, and generally suggest the (Medela) outer shield and suggest to the mom to try it both ways, with and without the insert. Also sometimes as the breast changes with later lactation, some moms find using the insert at that point helps extract milk better. In my hospital we have an "old" Egnell pump, don't know the name but it is big and chrome like similar to Medela classic. The kit is very rigid and comes with an insert which I think every mom so far says hurts if she uses the insert. What does everyone think>? Laurie Wheeler, IBCLC, MN, RN New Orleans Louisiana, s.e. USA _________________________________________________________________ Send and receive Hotmail on your mobile device: http://mobile.msn.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html