I wanted to share my story and hopefully save others money and frustration …
Part 1: Medela ignores women with small nipples
My DD arrived 4.5 weeks early, immediately following her birth I was visited by a lactation consultant who took one look at my nipples and without measuring handed me the 21 mm flange set, the smallest size Medela offers. The hospital only received a handful per month and the LC claimed they had to horde them for when someone like me came around.
The LC explained to me that DD would likely not latch until closer to her gestational 40 weeks so I would need to pump until DD was able. After 3-4 pumping sessions, the pain became excruciating on even the lowest pump setting. A white ring encircling my nipples become visible when I stopped pumping. These would later become red rings of peeling blisters. I could not continue and I was emotionally falling apart over it. I was certain I would dry up before my baby was ready to latch.
I could not see an LC until two days later, meanwhile after
sleepless nights, I determined I was smaller than a 21 mm using the cointest. Both of my nipples are smaller than a
dime. So after reading the bump forums and a few other resources I purchased
the pumping pals small-medium set and the maymom 19, 17, and 15 mm flange
I saw a second LC two days later, by then I was desperate for help. I explained to her my story and frankly she did not believe me. She started questioning my pain threshold and I patiently waited for her to get over her spiel about how she’d seen everything and if I couldn’t tolerate the lowest setting on the hospital pump, I would be screwed on my pump in style as it was more aggressive. Furthermore, Medela does not make anything smaller than 21 mm and she seemed to believe this was because it was not required. She actually measured and remeasured my nipples and conceded I was 11.5 (right) and 13 mm (left) pre-pumping. According to the fitting guides, I would need a 15 mm and 17 mm flange for proper fitting. Her contemplative response made me believe I have exotically small nipples. I felt vindicated but still freakish and more importantly, doubtful there would be a solution for me.
She directed me to follow a "blister avoidance" strategy and cycle through the 21 mm,
24 mm, and 27 mm flanges over the course of pumping to avoid developing blisters. I was willing to do this, but I
didn’t think it was sustainable especially for when I returned to work. It
would make a 20 min process into 30-40 minutes with all of the starting and
stopping especially on my medela pump in style with the mandatory letdown mode.
The next day, my amazon flanges arrived, here is my take:
1. Pumping pals:
The small and the extra small would have been right size for my nipples but did not fit my breast properly. I have large round breasts and small nipples, like a corn kernel on a grapefruit. I believe they would work well for small or tubular breasts but you have to shove your breast fairly deep into the cone to get the nipple positioned properly and that wasn’t happening for me. As a result, it caused the same issue of dragging my areolas into the flange, the dreaded white ring, and pain, albeit in a new location. I could add these to the “blister avoidance” pile.
I’ll note the medium was the correct cone size but the tube was too large, I think it was the equivalent of a 21 mm medela flange. Again, a decent amount of areola dragged in resulting in the white right and pain.
I tried many combinations and ended
up using a 19 mm for my left breast and 17 mm for my right. This is one size
larger than the sizing directions but was necessary as decreasing the size further increased total vacuum and ended up dragging my nipples farther into the pump cylinder than ever intended (probably why Medela does not make anything smaller than a 21mm).
Note, every combination caused areolas to drag into tubes but pain was
significantly reduced and bearable to me. Note, when you start the
pump in style in any mode with these small flanges, your nipples are immediately
dragged deep into the tube portion and it hurts! I was bracing myself each
Part 2: Avent to the Rescue
For weeks I pumped unhappily with the 19mm/17mm aftermarket
Maymom flanges, bracing myself each time for that initial tug. After
awhile, I noticed my 19 mm breast appeared to be losing supply and I grew
worried (note, DD still couldn’t latch so I was EPing). After more research, I
purchased the Avent Manual Comfort breast pump ($25) and pumped my 19 mm breast
empty with over twice the volume of the Medela. This was slightly painful with the standard flange
pads that came with the manual pump, I ended up purchasing the size small (19.5 mm) and the pain was eliminated. The pump “massages” (really this is more of a squeeze)
your breasts in addition to tugging the nipple. This worked much better for me!
I was ecstatic, I finally had a pain free pumping solution. I went ahead and purchased the Avent double pump and used that with the small flange pads for weeks. There are a few drawbacks to this system:
These and the fact I already had 2 medela pumps plus all the
parts made me hesitate with purchasing one for work.
Part 3: Maymom for the win!
After browsing the depths of amazon, I found this absolute gem
at the Maymom shop.
It essentially converts a 24 mm Medela flange into a small sized Avent massaging pad. Exactly what I needed! I had spent over $300 on my journey to finding this. I purchased and they work great and yes, you can handsfree pump.
Note, some milk does get trapped inside the flanges and reviewers noted but this is less than 5 ml. I would not have found this acceptable for colostrum but my mature milk supply it’s negligible.
Does anyone else have experience with pumping with small nipples? I would love to hear what worked for you!
Re: Difficulty Pumping with Small Nipples
Too Long; Did not read:
Medela is a terrible pumping system if your nipples are smaller than the 21 mm minimum size they offer. Because Medela just tugs the nipple, and you have less real estate to offer, your supply can drop with properly sized aftermarket flanges. The “massaging pad” inserts offered by either Avent (these only work on Avent pumps) or aftermarket by Maymom (for medela pumps) were my solution.
1. If you are starting out on your milk supply, and are sensitive to ~5 ml losses, use the Avent handpump on one breast, a haakaa on the other. Pump Avent for 10 minutes and then switch sides. Don’t forget to purchase the proper sized Avent pad insert (total $46)
I have used my haakaa and manual pump strategy over and over again (at night after I breastfeed in order to empty, as a passenger in a car when I don’t have time to breastfeed, when baby is fussy and I can’t sit down and pump between feedings, etc). Also, the haakaa is great as a milk catcher while breast feeding if you leak.
2. If you are mature in your milk supply and don’t mind 5 ml loss due to trapped milk, get the Maymom insert ($16)
First, the bad news, most of my massaging flange inserts became yellowed and sticky during 3 years of storage. The ones that survived were stored in tightly closed ziplock branded freezer bags. Kroger brand did not hold up. Avent no longer supplies the small sized flange cushions but there is a third party supplier on Amazon, begical, that does, these seemed to work ok although I haven't used them much. The previous supplier of the Medela inserts also no longer makes them, but there is another on Amazon also by begical. These seem to work well.
Now the good news, I haven't used much of the above because there is so much more available now! For my main pump, I was able to have my insurance cover most of the elvie stride cost https://a.co/d/3bhvveu (worked through pumping essentials as supplier). This is the economy version of the Elvie hands free super silent pump. I use this with a third party flange insert by nenesupply, https://a.co/d/94Jsce4 .
This works great! It's overall a gentler pump than any other I've tried and I get a let down almost every time i use it. It's quiet but not silent, it's about as loud as a toddler's attempt to whisper. You can't hear it behind a closed door but the person next to you would certainly hear it. It's also not quick, it takes about 25 min to get what I could from 15 min on the Medela. I love that it fits in my normal bra and I can walk around with it. The spare parts are expensive but I refrigerate the parts that touch milk in between pumps and i haven't needed any. I also purchased the bellababy wearable pump on a black Friday, https://a.co/d/dd7tvVy for $60. This is a much louder pump than the elvie, not as gentle (I found it a bit pinchy and did not get any letdowns at all), but the same nenesupply inserts also seem to work well and gets about as much milk as anything else. I did like that I could use one side at a time but in the end stopped using it in favor of the Elvie.
I did not pump a ton while on maternity leave because I found a great letdown pump to replace the hakkaa (My hakkaa pumps also yellowed and became sticky in storage). I loved my hakkaas but hated when they became loose and would fall off. Now I use an in bra pump, https://a.co/d/bQFc1O3. This is an off brand version of the elvie curve which sells for 50$. It frequently goes on sale for less than 20$. I absolutely love these. I use them for night feeding and first morning feedings on my non nursing side which is generally engorged at that point (I wear night nursing bras https://a.co/d/26Ellga ). I get anywhere between 3-5 oz per time, pour it into bags, and freeze them. I've gotten as much as 6 oz, this is the absolute limit after which you will get drenched (happened 2 times to me). This is not an active pump, it does have a small suction similar to hakkaa but mostly it relies on a letdown so I only use when breastfeeding. I find if I massage the engorgement during the feeding, I get more milk. I also have been using mother love more milk supplement and get on average 2 more oz from let downs at night after 2 days on the supplement. I think that's it, hope that helps someone!