Breast Flange Size - How Your Breast Pump Flange Affects Your Milk Supply

One of the most common breastfeeding questions we get is regarding a mom's breast pump.  What breast shield size will work best?  Choosing the correct breast pump flange is even more essential than choosing the correct nursing bra size, although both are important.  The figure below shows what a correct fitment inside your breast pump flange should look like.

It is imperative that there is enough room to draw the nipple into the flange so that the areola is compressed where the lactiferous sinuses are located.  As you can see from the image below, the lactiferous sinuses are located about an inch behind the nipple.  

This is where the majority of the milk pools before milk ejection which is why it is essential to compress the sinuses properly when pumping.  If the flange is too small, the nipple is compressed and not the milk sinuses.  

If the breast shield you received with your breast pump does not fit properly as in the first image, you need to seek out the correct size as soon as possible.  When the nipple is drawn into the flange, there should be adequate room on one or both sides of the nipple.  If not, examine your nipple at rest prior to pumping.  What is the diameter of the nipple?  Using an everyday object like a coin can help you determine diameter.  The image below will offer coin size comparison and tips on how to measure.

If you nipple is the size of a penny or even a nickel, the standard breast shield size that came with your electric breast pump may work for you.  This is because some of the brands offer a slightly larger flange than the most common breast shield size that were included with your Medela or  Spectra breast pumps which is a 24mm breast shield. For example, most Ameda breast pumps include an Ameda 25 mm breast pump flange. Hygeia breast pumps include a Hygeia 27 mm breast pump flange.  ARDO includes a 26mm flange.

But if your nipple fitment looks or feels too tight or if you can visually see that your nipple diameter is larger than a nickel, you will need to purchase a larger breast flange right away.  The following manufacturer's offer custom breast pump flange sizes for your convenience:

Ameda Custom Fit Breast Flanges replace ones in the Hygeinikit, Purely Yours, Ultra, Finesse and Ameda Mya Joy breast pumps have 28.5mm flanges and 30.5mm flanges available as well as 32.5 and 36 mm.
Ameda also offers a 21mm breast flange for Ameda Mya  and Ameda Mya Pro (does not fit Mya Joy),  24mm and 28mm Ameda Mya flanges as well as a 30mm flange.

Hygeia Large 29 mm breast flange and Hygeia X-Large 31 mm breast pump flange

Spectra 28 mm breast shields and Spectra 32 mm breast shields

ARDO 26 mm breast shells and 28-31 mm breast shells (AKA breast shields or breast flanges) and even an XXL ARDO 36 mm breast shell

For brands like Medela or Rumble Tuff, we recommend using Pumpin' Pal Super Shields so that you get the benefit of a better fitment and can avoid back strain due to leaning forward while pumping without an angled breast shield.

What if your breast shield is too large?  Some manufacturers are now offering a smaller flange such as the Spectra 20mm breast shield.  Inserts are also available from several manufacturers to make your breast flange smaller.  If your nipple diameter is the size of a dime or if too much of the areola is being drawn into the breast shield, try an insert.  Ameda offers the Ameda Flexishield which is a 21 mm massaging insert that will fit both Ameda and Medela breast shields.   This silicone massaging insert which actually helps with milk let down. I have seen moms pump an extra ounce of breast milk when using a Flexishield massaging insert.  This is due in part to the correct size for better milk sinus compression, but also because silicone massaging inserts like the Ameda Flexishield massage the areola much like the peristaltic wave of the infant's tongue when the baby is at the breast.  This action tends to assist the let down reflex.  Other breast pump manufacturers such as Hygeia, Rumble Tuff, Medela, and Bailey can be used with the Pumpin' Pal Small and Pumpin' Pal X-Small Super Shields.  The Pumpin' Pal small and x-small Super Shields yield some let down assistance as well due the movement of a flexible silicone breast shield.  

If the manufacturer of your breast pump doesn't offer the size you need, standard breast flange inserts are also an option.

Buying the correct size breast flange is as essential for milk supply as changing your valves, diaphragms or filters on your breast pump to maintain proper suction.  In addition, if the breast flange is uncomfortable, moms tend to pump less and wean sooner.  Here's to hoping this information impowers you to keep on breastfeeding and pumping!

Happy Pumping!

Tanya

If your Breast Flange Size Reducing Your Milk Supply?

If you have the wrong breast flange size, it can greatly reduce your output when your are pumping and decreasing the amount of milk extracted signals your body to produce less milk!
There are a lot of things you can save money on when you are breastfeeding, but getting the right size flanges and replacing essentials like valve and filters is not the place to scrimp as both those things can greatly reduce your milk supply.  I have created an image to help you determine your nipple size.  Use this as a guide to buying the correct breast flange size no matter what brand you have.  Some brands don't have a full range of sizes, which is why Pumpin' Pal is perfect!  Not only do their Super Shields help you lean back and save your back while you are pumping, their breast flanges now come in sizes from x-small 15mm to x-large that fit up to 40mm nipple diameter.  Remember the nipple diameter does not include the areola, just the nipple itself and it is easy to see when you have just finished nursing or pumping.

To find larger or smaller breast shields from Ameda, Spectra, Hygeia and ARDO, shop http://www.lactationconnection.com  

Here's is to happy pumping and more milk!

Tanya

Breastfeeding: Benefits of Nipple Cream

There are many things sold out there that you do not need for breastfeeding.  One example are hot compresses.  They can be expensive upwards of $20 for an item you use temporarily.  My suggestion for this is a disposable baby diaper.  It is imperative to soften breasts that are engorged before feeding or pumping with warm compresses, but a baby diaper run under hot water can be very effective and costs about .50 cents each.

And while some moms only need expressed breast milk to soothe their breast, having a good nipple cream around can be a lifesaver.  I recommend purchasing a quality nipple cream prior to delivery. That way, you aren't sending your hubby to the grocery store in the middle of the night and he comes home with something with pesticides or other substances that can be harmful to the baby and not
helpful to you.

While HPA Lanolin has been the go-to nipple cream in the past, many companies such as Ameda have discontinued carrying this product.  Today moms prefer an all-natural approach.  While there are several all natural nipple creams out there, moms prefer the soothing of coconut oil.  Coconut oil not only soothes and hydrates nipples, it offers anti-microbial and anti-fungal properties that most nipple creams do not.

So what are the benefits of breast milk and nipple cream besides a soothing feel and hydration? According to research sited below, there is evidence that the presence of ‘epidermal growth factor’ in breast milk has potential therapeutic benefit in promoting the growth and repair of skin cells. Moist wound healing results in wounds healing 50% faster when the internal moisture of the skin is maintained.  So, save your money and don't buy a commercial breast compress; but instead put a moist wound healing all natural breast cream like cocout oil on your shopping list for baby!

Happy Breastfeeding!
Tanya

References:
Mohrbacher and Stock (1997)

Renfrew, Woolridge and Ross McGill (2000)

Breastfeeding: Guide to Preparing for Breastfeeding

I have been asked to speak at an event at a Motherhood Maternity store in the next few weeks.  The topic, Preparing to Breastfeed.  There are many misconceptions about getting ready to breastfeed, but much of your success is about education.  You as a reader of this blog, are doing just that.  Getting a head start by getting information prior to delivery.  Knowing what is normal, what to expect and when to get help is essential.

Know Your Body

Watch for indicators that your body is getting ready to produce milk.  The most common is breast tissue growth.  Your breast should change and get larger before delivery.  You may or may not leak colostrum in the last trimester, but you should have some breast size change during the pregnancy.  

Check for flat or inverted nipples.  This is not a simple, look in the mirror exam.  You will need to put pressure with your thumb and index finger approximately 1" onto the areola (figure A) to see if your nipple protrudes or instead goes flat or hides when the areola is compressed (figure B).  

If you do find you have flat or inverted nipples, there are steps you can take.  If you are not at risk for pre-term labor, a nipple everter such as the Avent Niplette is a good option.  If you are high risk, then you will want to make sure you have a breast pump available for immediate use.  If you are waiting on an insurance pump, then purchase an inexpensive quality manual breast pump like the Ardo Amaryll.  This pump is a great value and can be used to evert the nipple prior to latch on by pumping for a few minutes before breastfeeding.  

Get Comfortable with Your Breasts

Common mistakes that moms make can lead to sore nipples so it is wise to know how to hold and support the breasts during feeding.  The C Hold is most commonly taught today, but many moms don't realize that the bottom half of the C is as important as the top.  Not only make sure that the thumb is not impeding the baby's latch on the areola, but make sure that the fingers underneath are not in the way as well.  It is very common for moms to have their fingers in the way so even when the baby wants to do a deep latch, they can only get so close due to the obstructive digits.   The image below shows the correct hold when latching the baby.

Don't Fall into Booby Traps

If you are getting advice such as you need to toughen up your nipples before breastfeeding, you need to think twice.  Much of the advice you get is anecdotal and not research based and some advice is simply just rooted in old wives tales.  Make sure the sources you are listening too are indeed breastfeeding experts.  (In the case of this blog, it is written by a retired international board certified lactation consultant with three children, two grandchildren and 23 years of experience in helping mothers meet their breastfeeding goals.)  Back to the case in point, nipples do not need to be toughened.  Rubbing nipples to prepare them for breastfeeding only breaks down natural keratin layer which makes you more prone to trauma.  The remedy, a good latch.     

Breastfeeding Education

The best way to prepare for breastfeeding is education so take a breastfeeding class at your local hospital, read a quality breastfeeding book not just a section of a book written for pregnancy.  I highly recommend The Nursing Mother's Companion by Kathleen Huggins.  If you are in a rural area and don't have access to classes, you can use youtube but make sure the instructor is qualified before you watch.  

Resources

Know where to get help before you need it.  Feel free to email me with questions, but finding out if there is a La Leche League group or a local lactation consultant that hosts a Latch Clinic is a great help.  You may even have an IBCLC who does home visits in your area.  This is information you want to have before you need it!

While you are preparing your home for your baby, make sure you have prepared with information, resources and education.  A few supplies can go along way to make things easier as well.  I recommend a nursing nightgown or nursing pajamas with integrated sleep bra that offers easy access but holds you nursing pads in place, a quality double electric breast pump with a closed system to prevent contamination and cotton breathable washable nursing pads.  Bottles are not recommended until the baby learns to breastfeed well which is usually after 6-8 weeks so if you are pumping for storage, add some breast milk storage bags to your shopping list.  And finally a nursing bra that fits multiple cup sizes like the Bravado BodySilk Nursing Bra or a less expensive alternative is the Amamante Caress & Contour Nursing Bra.  

Happy Nesting!
Tanya

Troubleshooting your Hygeia Breast Pump: When to Replace Hygeia Parts

If you are new to pumping, you want to know what to do about maintaining your new breast pump.   All breast pumps need to be maintained to function at optimal levels and Hygeia breast pumps are no different.

Getting Started

When you get your pump, remove the breast shield from the Hygeia tubing.  Then remove the valve from the breast shield.  Sterilize only the following parts:  breast shield, valve, bottle, bottle ring, disc and cap.  Do not sterilize the filter or tubing.  Sterilize using the top rack of the dishwasher, microwave steam sterilizer bag or boiling water.  If you use boiling water, bring the water to a boil and then leave in for no longer than 3-5 minutes or you will have cloudy or warped parts.  Do not use a bottle brush to clean breast pump parts.  Do not wash Hygeia filters.  Keeping the filters dry, helps maintain their integrity longer.

Re-assemble as per instructions.  If you has misplaced your instructions, you can download these Hygeia EnJoye breast pump instructions.  But remember, although these breast pumps have a closed system and when you purchase your own kit, you should not share these types of breast pumps with other mothers.  Although there is no cross contamination of yeast with a used breast pump, the motor is made to last for one baby and older pumps may compromise your milk supply.

Now that you have your breast pump re-assembled, set your pump to a fast speed and the highest suction level where you feel comfortable.  Too high of suction will not help the milk let-down if you feel discomfort.  Quick speed gives you the most cycles per minute which helps with milk production and double pumping increases prolactin levels which help with milk supply.  For a single baby pump for a full 10-15 minutes of double pumping even if milk stops flowing earlier.  This tells your body you want to produce more milk.  

Troubleshooting:  Replacing Breast Pump Parts

The most common problem with low suction on your breast pump is the result of a part in your kit. To keep your pump functioning at optimum levels, replace the Hygeia valve and Hygeia Bacteriostatic Filter parts every 100 pumping sessions.  For a mother who works 5 days a week and pumps 3 times per day, that is every 7 weeks.  The rule of thumb for the working mother is to replace these parts every 6-8 weeks. Other parts should be replaced as needed.  If you see pinholes in tubing, warped or scratched breast shields it is time to replace parts.  Other indicators are if you had a yeast infection as boiling will not kill yeast or if you see a tear in your valve.

It is important to keep replacement parts on hand so that a misfortune with a broken, melted or loss part does not interfere with your milk supply.  Having extra breast shields aka breast flanges are also a good way to keep from spending as much time cleaning your parts.  Before you purchase extras however, make sure that the standard size is comfortable.  You should have space on at least one side of the pump shaft for your nipple to move freely while pumping.  If there is no space or you feel discomfort, consider purchasing the next size breast flange.  

Maintaining your breast pump is a proactive way to keep your milk supply, but don't forget to pump frequently and don't miss feeding sessions without pumping.  For moms with babies under 6 months, that is 8 times per day of feeding or pumping and over 6 months, you need stimulation 5 times per day.  Ensure an extra 3 pumping sessions during growth spurts which occur at 3 weeks, 6 weeks, 3 months and 6 months.  These extra sessions are a good reminder to replace your pump parts and step up your number of pumping sessions for the full 5-7 day growth spurt period.

Happy Pumping!

Tanya

Troubleshooting your Spectra Breast Pump: When to Replace Spectra Breast Pump Parts

Today's consumer wants plug and play electronic equipment, but breast pumps require a little more preparation.

Getting Started

When you get your pump, remove the breast shield from the backflow protector.  Then remove the valve from the breast shield.  Sterilize only the following parts:  breast shield, valve, bottle, bottle ring, disc and cap.  Do not sterilize the filter aka backflow protector or tubing.  Sterilize using the top rack of the dishwasher, microwave steam sterilizer bag or boiling water.  If you use boiling water, bring the water to a boil and then leave in for no longer than 3-5 minutes or you will have cloudy or warped parts.  Do not use a bottle brush to clean breast pump parts.  Do not wash backflow protectors.  Keeping the filters dry, helps maintain their integrity longer.

Re-assemble as per instructions.  If you has misplaced your instructions, you can download these Spectra S2 breast pump instructions.  But remember, although these breast pumps have a closed system and when you purchase your own kit, you should not share these types of breast pumps with other mothers.  Although there is no cross contamination of yeast with a used breast pump, the motor is made to last for one baby and older pumps may compromise your milk supply.

Now that you have your breast pump re-assembled, set your pump to a fast speed and the highest suction level where you feel comfortable.  Too high of suction will not help the milk let-down if you feel discomfort.  Quick speed gives you the most cycles per minute which helps with milk production and double pumping increases prolactin levels which help with milk supply.  For a single baby pump for a full 10-15 minutes of double pumping even if milk stops flowing earlier.  This tells your body you want to produce more milk.  

Troubleshooting and Breast Pump Parts

The most common problem with low suction on your breast pump is the result of a part in your kit. To keep your pump functioning at optimum levels, replace the Spectra valves and backflow protectors every 100 pumping sessions.  For a mother who works 5 days a week and pumps 3 times per day, that is every 7 weeks.  The rule of thumb for the working mother is to replace these parts every 6-8 weeks. Other parts should be replaced as needed.  If you see pinholes in tubing, warped or scratched breast shields it is time to replace parts.  Other indicators are if you had a yeast infection as boiling will not kill yeast or if you see a tear in your valve.

It is important to keep replacement parts on hand so that a misfortune with a broken, melted or loss part does not interfere with your milk supply.  Having extra breast shields is also a good way to keep from spending as much time cleaning your parts.  Before you purchase extras however, make sure that the standard size is comfortable.  You should have space on at least one side of the pump shaft for your nipple to move freely while pumping.  If there is no space or you feel discomfort, consider purchasing the next size breast shield.  

Maintaining your breast pump is a proactive way to keep your milk supply, but don't forget to pump frequently and don't miss feeding sessions without pumping.  For moms with babies under 6 months, that is 8 times per day of feeding or pumping and over 6 months, you need stimulation 5 times per day.  Ensure an extra 3 pumping sessions during growth spurts which occur at 3 weeks, 6 weeks, 3 months and 6 months.  These extra sessions are a good reminder to replace your pump parts and step up your number of pumping sessions for the full 5-7 day growth spurt period.

Happy Pumping!

Tanya

Comprehensive Guide to Increasing Breast Milk Supply

Your body makes milk on a supply and demand basis. Although we don't need ounce markers on the side of our breasts to know the baby is getting enough, we tend to fret over milk supply.   Here is a comprehensive guide to ease your worries and address your concerns.

Is my baby getting enough?
When your baby is first born, his wet diapers should increase daily. On day one, he should have at least one, day two, he should have two, up until day six. After six days of age, they have six to eight pale wet diapers daily and three to four "cottage cheese and mustard" stools. Other ways we can tell the baby is getting enough milk is that he makes quiet swallowing sounds at the breast. The breast feel full before the feeding and softer afterward. The baby seems satisfied after twenty minutes of swallowing. Babies may loose 7-10% of their birth weight, but begin regaining at day 6 and gain 5-7 ounces per week on the average until 6 months of age. The stools can change at 4-6 weeks of age. Only if your baby is not gaining well, invest in a baby scale that you can use to monitor breast milk intake and growth. You will want a scale that shows 1/2 oz increments or greater.

Do I need to drink more water?
Water does not make milk, but make sure you are drinking to thirst. If you are dehydrated your body does not function optimally.  
Can I increase my milk supply with supplements?
If you want a boost increasing milk supply, there are several galactagogues on the market. Fenugreek is safe and effective and can be found in most areas. Make sure you are talking a quality brand like Nature's Herbs or Natures way in an appropriate quantity.  You should take 600-626 mg capsules that only contain Fenugreek.  This normally increases milk supply in about 48 hours.  If you are an average size mom, you should take three capsules, three times daily so 9 per day.  Plus size moms can take up to 5  600-626 mg capsules per dosage for a total of 15 per day.  Make sure you are not getting loose stools and check milk supply after 3 days by nursing the first session in the morning and then double pumping with a good quality double pump like the Hygeia EnJoye LBI, Spectra S2, or the Ameda Finesse Breast Pump for 15 minutes. 

How much is enough?
You should be yielding 2.5 oz per lb of baby's body weight per day.  To calculate if you are making the appropriate amount take your baby's weight for example 8 lb multiply by 2.5 which in this case would equal 20 oz per day.  Then divide by 8 times per day for a baby under 6 months.  This means from both breasts you should be making 2.5 oz for an 8 lb baby.  Here is a link to a page where you will find to an easy to read milk intake feeding supply chart.

Can my baby help increase my milk supply?
Yes!  If your infant will suckle at the breast, this is a highly effective way of increasing milk supply.  Offer the breast every 2 hours with a longer stretch at night for a minimum of 12 feedings per day.  If the infant will suckle for at least 20 minutes each time, your milk supply should increase by day 6.  Remember, breast milk adheres to the supply and demand rule, so the more you demand, the better the supply.

Can I increase my milk supply with a breast pump?
Yes!  If your baby will nurse frequently even if milk supply is low, use the baby; but if your baby will not latch or will not stay latched long enough for you to get adequate stimulation, by all means use a quality pump like the Hygeia EnJoye Cordless, Spectra S2, Ameda Finesse or the Ameda Platinum Breast Pump.  If your baby is under six months old, you should be pumping or nursing at least 8 times per day for 10-15 minutes of double pumping.
If you are already nursing eight times per day, use your breast pump to simulate a growth spurt.  Studies show that you need one hour of additional stimulation per day to increase milk supply.  Pump an additional 10-15 minutes three times per day for five days in a row to simulate a growth spurt and increase milk supply.  If you miss a day, start the process over. You can accomplish this by moving feedings and or pumping to every 2 hours instead of every three or pump.  Frequency is better than duration for increasing milk supply so don't cheat by making pumping times longer.  They need to be more often.

Are there other supplements that help with maintaining milk supply?
Motherlove More Milk Plus comes in a liquid filled capsule with just the right combination of galactagogues to increase milk supply in most mothers.  In addition, products from Motherlove offer specific instructions for dosage in relation to lactation.
There are several other supplements that I would recommend substituting for snacks. Instead of a cookie, grab a Milkmakers Lactation Cookie.  Moms do need an additional 500 calories per day to make milk.  Most of us get them instinctively, but if you are already over your calorie limit, a good mothers milk tea is a good option.  

Are there other tips for maintaining a healthy milk supply?
Busy moms can sometimes miss feeding and or pumping.  Don't just forget them, make up for missed pumping times at work when at home or put later in the day pumping closer together if you have a meeting.  If you are out for a short time and someone else is fed the baby before you could make it back, make sure to pump immediately upon return.  This helps milk supply as well as restocking your freezer.

Is my body capable of making enough milk?  
Insufficient milk supply syndrome is actually very rare.  A mother with a complete mastectomy on one breast can still nourish a baby just as a mother of twins can nourish two. Most milks supply issues are about mismanagement of stimulation of the breast and insufficient extraction of the milk, making your body think it doesn't need to make more.  
What other tips do you have for managing milk supply?

• Nurse within the first 30 min to 1 hour after birth, delaying the bath for skin to skin contact.
• Try to minimize engorgement and don't leave engorgement unresolved.  Nurse often, waking the baby every 2-3 hours.  Use warm compresses and a breast pump if the breasts are too hard for the baby to latch on.  The first day, the baby tends to sleep longer after the initial hour after birth, but continue to try and after that 6-10 hour period increase your efforts.
• Don't miss feeding unless you are pumping.
• Don't forget about growth spurts when you are working.  If you are away from your baby at the 3 week, 6 week, 3 month or 6 month time period, pump every 2 hours instead of every 3 for a total of 11-12 nursing or pumping sessions per day.
• Delay solid foods until the baby had not only double his birth weight but is sitting alone unassisted.  Sitting without help (even from a Boppy) coincides with the loss of a tongue thrust reflex that indicates readiness for solids.
• Feed solids only after breastmilk.  Breastmilk is still the main source of nutrition for at least the first year so do not fill the baby up on inferior food.  Nurse or give breastmilk first.  Besides, who wants green beans on your breast?

Here's to a healthy milk supply!
Tanya

References:
Fenugreek: One Remedy for Milk Production by Kathleen Huggins, RN, MS
Fenugreek: Overlooked but not Forgotten by Rima Jensen, MD

Updated:  2/19/19