16mm 17mm and 19mm Small Breast Shield Size: What To Do When the Smallest Breast Flange is Still too Big!

Recently, several moms have contacted us regarding the smallest flange a manufacturer makes still being too big.  Moms are reporting that too much of the areola is being pulled into the tunnel of the breast flange and they are not emptying their breast well when pumping.  

From what I have seen in my twenty-eight years experience in the lactation field, this problem is occurring more and more today than it did in the past.  

One explanation is that there is currently a culture of over-hydrating.  

How can water be bad?  

Of course water is a good thing, but hyperhydration causes lower milk supply by causing the body to excrete more fluids rather than making more milk and it actually changes your skin turgor aka elasticity. This is why these recommendations can help you when the smallest breast flange is still too big.

1. Reducing water intake to normal “drink to thirst” levels rather than over hydrating with a large number of ounces per day can help reduce the elasticity in your nipples.
2. Do not use lubricants aka nipple cream or pumping spray on your breast while you are pumping if too much of the areola is being drawn in. While these are normally helpful products, they may cause too much of the areola to be drawn in if your breast flange is too big.
3. Re-position the breast shield every 3-5 minutes to be slightly off-center.  This will engage more of your milk ducts to help you drain your milk sinuses more effectively.

What do I watch for when reducing my hyperhydration habits?

    1.  Check your urine color. It will be darker than pre-pregnancy even with normal hydration because of the proteins excreted during lactation but if it gets too dark, you are reducing too much.

    2.  Drink to thirst.  You should not be going around why dry mouth or lips.  If you are thirsty, drink water!

    3.  Your skin turgor should return to normal after 3-5 days of changing your drinking habits.  If this does not help your flange fit better, you may need to go with an aftermarket brand that will fit you better.

How do I find a flange that fits me if my pump manufacturer doesn't make one?

If you have a Medela, Hygeia or Lansinoh Breast Pump, Pumpin' Pal offers an x-small silicone flange which fits 15mm 16mm nipple 17mm and 19mm nipple.

If you have a Spectra breast pump, Ameda Mya breast pump  (not Mya Joy) or Motif Luna breast pump, Pumpin' Pal offers an x-small silicone flange with connector for Spectra, Ameda and Motif.  Pumpin' Pal fits nipple sizes 15mm 16mm 17mm and 19mm and works with those pumps perfectly with the Pumpin' Pal Spectra adapter which also works with Ameda Mya and Motif Luna.  

If you have an Ameda pump such as the Platinum, Elite, Purely Yours, Finesse, or Mya JOY that uses the Ameda Hygieinkit  and the 21mm Ameda Flexishield is still too big, you may have felt like you were out of luck.  You can now use the Pumpin' Pal X-Small Flange and other Pumpin' Pal sizes with an Ameda connector for the Ameda breast pumps that use the Ameda Hygienikit.  The Ameda Hygeinikit connector is unique shape that fits the Ameda diaphragm so if your Ameda flange does not have this diaphragm chamber, this is not going to work with your Ameda pump.  In that case, you probably have the Ameda Mya instead of the Mya Joy and you need the connector Mya Adapter.

Otherwise the Pumpin' Pal X-Small with Ameda adapter may be right for you. 

We love to recommend Pumpin' Pal because their flanges have helped so many moms over the years.  So much so, that they were referred to as "supershields", but as with any product not every mother has the same experience.  To get the most out of your silicone supershields, read the Pumpin' Pal Start Guide so that they adhere to your breast for best performance.

So, how should your breast flange fit?

1. It should be loose enough that the nipple moves back and forth without pain.
2. It should be tight enough that not much if any of the areola is drawn into the tunnel.
3. You should not experience redness or discoloration after of the nipple and areola after pumping.
4. You should not experience blanching (area turning white) where the flange touches.

Another sign that your breast flange aka breast shield is not fitting properly is if you breast do not feel emptied after pumping.  Please note that breast may not feel empty 3-7 days after delivery due to an engorgement period when the breast feel full due to swollen tissue.

Best wishes for a good fit!

Tanya

Dad's Guide to Bottle-feeding Breastmilk

As our world has changed over the last two years with more parents are working from home and sharing the responsibility of feeding the baby.  My own son is expecting his first and his wife will be working outside the home while he runs his business from home.  

Since babies don't come with an instruction manual, Dads and other caregivers can benefit from some advice on feeding while mom is away.

#1.  Introduce the Bottle at 6-8 Weeks

This time frame is optimal because it allows enough time for mom and baby to establish a good latch and breastfeeding rhythm.  Waiting longer than 6-8 weeks can sometimes make it more difficult for baby to want to transition from breast to bottle.  The goal is to use this window of opportunity so that baby goes back and forth from breast to bottle seamlessly.  

#2.  Choose the Bottle with Intention

The intention behind choosing a bottle is that the nipple had a wide mound so that baby opens wide simulating the same latch as they would on the breast.  The bottle nipple should be silicone and not rubber that has a smell and taste and should be a slow flow or newborn nipple.  Some recommended bottles and nipples are Spectra, Motif Luna, Hygeia and Comotomo.  

#3.  Schedule an Introductory Trial Run

It may be difficult for Dad or any caregiver to try to introduce a bottle with mom is nearby.  Plan a time that mom has a short outing and when it has only been 2 hours since the baby has fed.  Waiting until the three hour mark increases the infant's agitation and willingness to try a new way of feeding.

#4.  Position Baby

Make sure the baby's head is above their body.  Most images you see of bottle feeding have baby in a cradle hold with the bottle above them which can be effective.  When using a cradle hold, the crook of your elbow is lifted so you may want an extra pillow on the armrest so your arm doesn't get fatigued in that position.  If the infant is refusing the bottle in this position, there are several other positions to try.  One is to simulate the position at the breast, hold baby tummy to tummy with you and hold the base of the bottle close to your chest.

#5.  Take it Slow

It is important to slow down the feedings as bottles drip automatically and can cause the infant to feed too quickly getting more air and taking in more breastmilk than mom is producing.  One way to slow the feeding is to stop and burp after each ounce.  

It is important not to offer baby more than the appropriate amount for weight gain or you may undermine moms confidence in her milk production.  So the next question is, how much does the baby need?  To calculate the infant's need, take the baby's weight and multiply by 2.5 which will give you the number of ounces per day. Divide this number by the number or feeding per day which is normally eight.  This will give you the number of ounces per bottle.  But who has time to do math with a new baby in the house so below is a handy chart for you to use.

Once the baby gets used to the bottle, it can be daunting if they finish quickly and still act as if they are hungry.  It is evident a baby over 6 days of age is getting enough by the wet diapers which should be 6-8 per day.  The number of dirty diaper can vary but generally 3-4 per day up to 3 months and then can slow down to one every three to five days. It is also important to know that an infant going through a growth spurt which is typically 3 weeks, 6 weeks, 3 months and 6 months will act hungry and mom may need to increase her pumping schedule for 5 days in a row to boost her supply to match the baby's demand.

#6.  Know How to Handle Breastmilk

As anytime you feed an infant, you will want to wash your hands.  But there is much more to know about how to handle breastmilk when it comes to storage, thawing and feeding.  

Breastmilk is good at room temperature for 4 hours, but if the baby pauses a feeding it needs to be used within a 2 hour window.  It is good in the refrigerator for 4 days, but you should then use it and not freeze it as you have used up the life of the milk.  It is good in a freezer for 6-12 months but you should not store it in the door and you should never re-freeze thawed breastmilk.

When thawing breastmilk, it is best to do this in the refrigerator overnight, on the counter for three hours or in a container of warm, not boiling hot water.  You can also use a commercial bottle warmer provided it has a thermostat reading as breast milk is best served between 77 degrees and 98.6 degrees Fahrenheit for optimal digestion. If you are thawing breastmilk, use the oldest milk first.

Use fresh milk whenever available.  While it seem reasonable for mom to pump and stockpile her freezer, using frozen stock on the first workday of the week is good, but the rest of the week use Monday's expressed milk to serve on Tuesday, etc.  The reasoning behind this is that freshly expressed breastmilk has living white blood cells in it that are no longer living when frozen. Don't get me wrong, frozen milk is still far superior in nutrition and antibodies than artificial infant milk, but the fresh milk is optimal in those while blood cells providing greater active immunities for your baby.  In addition, breastmilk changes over the months so that as the baby grows and the needs of the baby grow, the milk expressed at that time is age appropriate in it's benefits as shown on the infographic below.

#7 Encourage Mom

Expressing breastmilk for baby takes time and commitment.  Remind mom that she is leaving her baby a gift every time she leaves breastmilk for a feeding.  Breastmilk is liquid gold and liquid love for her baby and this provision can help mom in the transition from being home to being away from her precious infant. Another bit of encouragement and boost to milk supply is to pack her bag with a water bottle, nutritious snack or lactation cookie bar. And of course a nice note in her pump bag every now and then never hurts!

Best wishes for Bottle Feeding Breastmilk!

Tanya

P.S.  Feel free to leave questions!

Which Bottle Nipples are Best for Breastfeeding?

Recently a question came in from an expectant mama as to whether the Avent bottles were best for breastfeeding.      

In years past, I recommended Avent bottles more often than not.  Today, with design changes to Avent and other great choices on the market, I thought I would help this mother and others with information on choosing the right bottle for your baby with today's blog.

Nipple Confusion and Flow Preference

First, let me say that introducing a bottle before six weeks can be problematic.  It is essential that your baby learn to latch well and nurse from the breast frequently during not only the learning period but also during the three week and six week growth spurt phase so that mom's milk supply can be stimulated by the increased suckling during those time periods.  Infant's nurse differently from a bottle which is why the term nipple confusion is prevalent.  When nursing from the breast, the baby uses a wave motion to draw the nipple into the mouth, but when using a bottle the baby traps the bottle nipple in the roof of the mouth or thrusts the tonged toward the bottle nipple opening to control the overwhelming flow from the bottle. In addition, feeding from a bottle gives the infant immediate gratification whereas the infant must suck for approximately 30-60 seconds from the breast to achieve let-down. As human beings, we tend to prefer immediate gratification even thought this is not best for the infant.  Suckling at the breast aids in tooth and jaw development in addition to many other benefits. If there is a medical need to supplement prior to the six week mark, a feeding syringe is best to avoid preference of a faster flow.  See our blog post on syringe feeding.

Introducing a Bottle

Once the infant has passed the six week growth spurt and you are ready to introduce a bottle, the type of bottle nipple used can make for a smoother transition from breast to bottle and vice versa.  I always recommend silicone slow flow nipples with a large area for the baby to latch.  See image below for an example of this type of bottle nipple.  

Shallow or narrow nipples do not allow for the infant to flare out or rosebud their lips like they do on the breast. Or at least not onto a soft are but only only onto hard plastic.  This shallow nipple discourages infants to take enough of the nipple into their mouths.  This behavior can transfer to breastfeeding causing the infant to only take moms nipple and not at least the recommended inch of the areola into their mouth.  If this shallow latch happens on the breast, it causes nipple pain in mom and poor milk transfer for the infant.  The milk transfer is not well achieved unless the infant latches onto the areola where the breastmilk pools in the milk sinuses.  Pacifiers with this breast-like shape are also recommended such as the Ninni Co Pacifier.

Below are some links to bottles and nipples that meet the criteria for the infant to latch well onto the bottle and back onto the breast:

Spectra Bottles with Nipples

Motif Luna Bottles and Motif Luna Nipples

Many experts believe that in addition to a wider base, a graduated sloped shape is recommended such as the Evenflo Balance Nipples as optimal for infants.  

Nipple Flow

In addition, breast fed babies feed more efficiently due to their increase in jaw development so there is no need for a higher volume flow when purchasing nipples.  You only need to purchase slow flow or newborn nipples in most cases unless your baby has suck difficulty or tongue tie, etc.  Bottle companies often put an age range on nipples to encourage moms to purchase more from the company, but you only need to replace nipples when they yellow or if they drip too quickly. If you baby needs an even slower flow, the Pigeon Super Slow Flow can be very beneficial and it is compatible with Spectra, Motif and Lansinoh wide-mouth bottles as well as the Evenflo Balance + GLASS bottle.

Pigeon Nipples

Best wishes as you prepare for baby!

Tanya

Back to Breastfeeding: Transitioning from Bottle to Breast

Recently, we had a question from a mother whose baby was unable to nurse from the breast effectively because of a severe tongue tie.  From experience, we know she is not the only mom with questions about how to get a baby who has been bottle-fed for weeks back on the breast so our hope is that this blog post helps Bev and the other moms in her situation.

There are several things you can do to encourage an infant who is bottle feeding to take the breast.  One size never fits all in counseling nursing mothers, so we will outline a myriad of techniques so that you can find one the one that helps you the most.

Start by changing the way you supplement.  The best method is to go from a bottle to finger feeding with a syringe.  A 10cc syringe is 1/3 of an ounce.  This will help you determine how many times to fill the syringe for a feeding.  When finger feeding with a syringe, put your feet up on a stool and lay the baby on your lap facing you.  Then insert a clean finger, pad side up.  Once the baby begins suckling, place the syringe in the corner of their mouth and wait for 30-60 seconds before tapping the baby feeding syringe.  Syringe feeding will help the baby use his tongue properly instead of arching or thrusting his tongue as when bottle feeding.  This method also slows down the feeding unlike a dripping bottle so that there is not immediate gratification but instead proper suckling several times, then yields the result of you tapping the syringe and releasing the milk.  This is important because it takes 30-60 seconds for breast milk to be released.  

Change the way you bottle feed.  If syringe feeding is not feasible, especially if your infant is in child care while you work, you can change the way that bottle feeding is done so that it can help as well. Holding a bottle fed baby the same way as you would feed a nursing infant can help transition the baby from bottle to breast. This means the baby should be tummy to tummy with you while feeding from a bottle.  Hold the bottle close to your collar bone so that the infant is not on its back when feeding.  Make sure the infant has lips wide apart.  If clamping the tip of the bottle nipple, gently screw the bottle in like a lightbulb and it will help the infant rosebud their lips.  If an infant does not open wide on the bottle, they will not open wide at the breast and milk transfer will be inefficient.  The milk sinuses are located about an inch behind the nipple so a wide mouth is essential in breastfeeding effectively.

Take advantage of prime time opportunities.  There are several times when infants are more disposed to breastfeeding.  These are times when their natural instincts kick in.  These times include falling asleep, not yet fully awake and when mom and baby are in a warm bathtub together.  Have a syringe full of breastmilk available when taking advantage of these prime time opportunities and that way you can drip breast milk on your nipple (you can also hand express first instead).  Lay the sleepy or bathing infant at your breast with your nipple exposed and gently guide them to nurse.

Try a nipple shield.  A baby who is used to the feel of a silicone nipple in their mouth may not respond to a bare nipple.  A nipple shield is one way to transition.  Make sure that you change your bottle feeding position from baby on their back to tummy to tummy for at least 2-3 days prior to trying the nipple shield.  Wet the nipple shield to help it adhere.  Massage your breast so that milk begins to drip into the nipple shield before attempting to latch.  Please note that if you are using a nipple shield for more than a few days, you will need to use a breast pump 1-2 times per day since it is a physical barrier that can lower milk supply without the added stimulation of pumping.

If your milk supply is low, use a lactation aid feeding tube.  If you are getting your baby latched, but they keep disengaging because milk is not flowing, a lactation aid feeding tube which can draw from a syringe or a bottle for supplement can help keep the baby at the breast.

Remember, your baby prefers you!  It is often such a blow to our ego as a mom, when a baby refuses the breast.  Your thoughts are that the baby prefers the bottle.  Just know, this is not a personal rejection.  Your baby has just learned another habit of feeding.  The good news is that babies learn habits quickly, so they can also quickly change their habit. But even if your baby never learns to nurse from the breast, you are still their favorite! And any means that you can use to get breastmilk in your baby is a win!

Be patient.  Try these techniques, then try them again.  Use what works, and toss what doesn't work for you and your baby.

Here is to a good latch!

Tanya

Is a Wet Dry Bag for Breast Pump Parts a Good Idea?

With all the things you need to buy for baby, is purchasing a dry bag for breast pump parts a waste of money or a good idea? That all depends on whether the bag is actually made in a way to promote healthy drying of your pump parts so we will look at the most common questions moms ask about breast pump parts bags.

Can I use a Ziplock bag?

You should use a sealed plastic zipper bag for your wet breast pump parts.  Besides the environmental concerns of over-use of these bags, the main reason is that moisture and warmth promote the growth of yeast and mold and that is certainly not what you want for parts that are collecting your baby's precious breastmilk. So to answer another common question, do breast pump parts need to be dry?  As you can see from the previous topic of yeast and mold...yes!

What about wet dry bags?

Wet dry bag were designed to put in wet clothing such as your baby's soiled clothes or a swimsuit and keep the rest of the items in your bag dry.  Although you see them marketed as "breast pump  parts bags", they are not any healthier than Ziplock bags as shown below where one brand is obviously growing mold. In my option, while the cute prints of these wet dry bags are enticing, they are a complete waste of money if you are using them for breast pump parts rather than soiled baby clothes.

What should I use?

Bags that have a small weave, but are fully breathable are best for air drying breast pump parts.  We love this one by Breastmilk Bandit.  The Breastmilk Bandit Store and Dry Bag is made with fine breathable mesh, a durable zipper and even a hang-dry loop so breast pump parts dry even faster.  If you are are trying to get Medela tubing dry, the hang-dry method is optimal.   Attaching tubing to your pump and letting it run may work, but it wears out your pump faster and it is much less expensive to replace tubing than the breast pump.

Alternatives that do work are bags like the one below by Pumpin' Pal.  The pros are that it is priced a dollar or two less, but it is draw string instead of the more secure zipper closure that Breastmilk Bandit's bag offers. Air dry bags such as the one from Breastmilk Bandit are less expensive that wet dry bags like the one from Sarah Wells and are a much healthier way to store and dry your breast pump parts.

Here is to safe drying!

Tanya

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2024 UPDATE!  

Breastmilk Bandit Air Dry Bag now includes a carabiner so you can clip to hang dry anywhere!

Best Breast Pump Bags for Work or Travel

One of your most important purchases if you are pumping on the go for your baby, other than your breast pump is your breastmilk cooler bag!  Getting the right bag is essential for protecting your liquid gold!

What should you look for in a breast milk cooler bag?  You want a well insulated bag with a good tight zipper that will hold enough breast milk for your baby at daycare of for your day of pumping.  Below are some tried and true cooler bags that we recommend for our nursing mothers.

4 Bottle vs 6 Bottle Breastmilk Cooler

If you work part-time, a 4 bottle bag is sufficient; but for a full 8-10 hours between work and home, you will want a six bottle cooler.  The main reason for this is that you can pump three different times into different bottles so your 98.6 degree milk doesn't warm up previously chilled breast milk.  You can consolidate your expressed milk later, but you always need to chill breast milk prior to adding to previously pumped and chilled milk to avoid reducing the longevity of the previously expressed breastmilk.

JuJuBe offers several high quality bottle bags that can be used for breast milk storage.  One is the JuJuBe Fuel Cell and the other is JuJuBe Be Cool.  They will both hold ice packs and up to 4 wide mouth bottles in a stacked position.

Pros:  Holds up to 4 wide mouth bottles and 2 ice packs. Stylish bag can be used as a lunch bag for mom or school-age child.

Cons:  Bottles must be in a stacked position, which may not be convenient for every situation.

Ameda offers an excellent breastmilk cooler cooler bag that includes three ice packs.  It can hold up to six standard bottles and three ice packs, but will not fit with bottle caps.  If using wide-mouth bottles, you can only fit 4 instead of six.

Pros:  Holds up to 6 standard bottles and 3 ice packs. 

Cons:  Only holds 4 wide-mouth bottles and is not tall enough to use with bottle caps if you are transporting bottles with nipples to child care.

Breastmilk Bandit has a great insulated breast milk cooler bag that holds up to 6 standard or wide mouth bottles and is tall enough to accommodate bottle caps to transport bottles with nipples to day care. This bag is perfect for use with breast pumps that include wide mouth bottles such as Spectra bottles, Ameda Mya bottles and Motif Luna bottles.

Pros:  Holds up to six 5oz standard or wide mouth bottles and 3 ice packs and is tall enough for caps to transport bottles with nipples to day care.  

Cons:  Because of the 6 bottle capacity, it is slightly larger than most cooler carriers so will most likely not fit inside a standard breast pump tote bag.  One suggestion is to use a carabiner clip so that you can attach it to your bag while you are on the go.

What about ice packs?

Gel Ice Packs vs Blue Ice Packs

There is a big difference with how long breast milk will stay cold in your Breastmilk Cooler Carrier when you choose a soft or gel ice pack vs a hard ice pack also known as blue ice.  The gel packs just do not stay frozen long enough to get you past lunch-time in even the best cooler carrier.  Hard ice packs are the best choice.  Choosing a slim hard ice pack and using at least 2 for 4 bottles and 3 for 6 bottles will allow you to fit the optimal amount of ice packs and bottles into these cooler carriers so that your milk stays cold for 8-10 hours as needed.

What about freezable breast milk cooler bags?  Unfortunately, cooler bags that are freezable also use a soft gel ice pack sewn into the bag which does not keep the breast milk cold long enough for the pumping working mother.

As always, I hope this blog helps you navigate your pumping needs.  Happy transporting!

Tanya

Technology in Breast Pumps - Spectra Synergy Gold SG Dual Powered Breast Pump -

We were first notified of the latest innovation in breast pumping technology and have been waiting to get our hands on their incredible new breast pump, the Spectra Synergy Gold.  This pump has dual power, not to confused with just dual or double pumping.  It actually allows the breasts to be stimulated independently so you can increase the suction on the lazy breast to encourage more milk extraction.  This type of technology is what double pumps were going for when they were first invented by Einar Egnell, founder of the Ameda Egnell company back in 1942.  But not much has changed in this field other than portability and speed.  Dual electric pumps became smaller, faster, more portable and some are even wearable. As I said, not much has changed, until now!

What is different about the Spectra Synergy Gold Breast Pump is that is had dual motors that operate independently.  Why is that helpful?  Double pumping increases prolactin for increased milk production, but until now each breast had to be treated the same.  The same number of sucks per minute at the same level of suction.  But as you know, your breasts aren't twins - they are more like sisters.  Allowing for each breast to be treated individually allows you to increase suction more on one breast.  Think of this pump more like nursing twins.  Even twins have different needs when it comes to pace of feeding and different abilities when it comes to strength of suction.  

While the new Spectra Synergy Gold Breast Pump has the most advanced technology in the industry, it has retained the hallmark features for which Spectra is known.  The Synergy Gold has a true closed system with a hygienic barrier to prevent breast milk contamination, has a mild indirect light for breastfeeding at night or use as a night light, and uses the same Spectra accessory kit as other Spectra breast pumps so if you are upgrading to the Synergy Gold Breast Pump, your Spectra breast pump parts and Spectra bottles are compatible.  And Spectra offers 20mm, 24mm 28mm and 32mm genuine Spectra breast shields.  

The Spectra Synergy Gold Breast Pump offers the same 270 mmHG strength of suction as the Hospital Grade Spectra S3 Pro.  It is ultra quiet and has a timer control, 3 levels of light illumination, LCD touch screen with dual controls for each breast, timer and mute mode.

So you can see the difference between the Spectra Synergy Gold settings vs the Spectra S2 as well as other pumps, below is a chart showing the details of the strength of suction and speed of this exceptional breast pump!

And I may be a lactation nerd, but can I say this pump is sexy!  Love the name of this pump and white and gold color scheme which makes you feel like a lactation professional even if you aren't one...lol! After all the definition of synergy is a cooperative action between two in order to produce a combined effect greater than the sum of their separate effects. Like most of you, we were happy to have 2020 in our rearview mirror for a myriad of reasons and are happy to have the Spectra Synergy Gold Breast Pump now available!

Synergy Gold breast pump parts are similar to the tried and true Spectra S1 and S2 breast pump parts with the exception of specialized SG tubing.  Spectra white duckbill valves and backflow protectors are the same in the Synergy Gold.  Replacement Synergy Gold Breast Shield Sets with SG tubing can be purchased as well.  

Here is to more effective pumping!

Tanya

www.lactationconnection.com