Posted on

Choosing the right breastshield for you

Did you know that breast shields ( flanges) come in different sizes? Many mummy experience inefficient pumping session, and the reason is usually because of wrong breast shield size. Many breast pumps ship with size 27mm or 28mm in Singapore; however, that doesn’t mean that everyone will fit that size (we don’t all wear the same sized shoes, after all). There are breast shields on the market ranging in size from 15mm to 36mm!

Follow this simple guide to determine your breast shield size but first thing first

Pump for 5 minutes, and then measure

It’s a common misunderstanding to measure your nipple before you start pumping, but you actually have to measure the nipple after you pump. The reason is simple. The nipple swells while pumping, and since the rate of swelling varies between women, it’s important to take this swollen measurement to select a comfortable shield size. Grab the shield that came with your pump, assemble it to the milk collection kit and then pump on a low setting for 5 minutes, so the nipple swells. You might even express milk while doing this (if this is your first time pumping, be sure to use the lowest vacuum setting to avoid any pain or discomfort).

Measure the diameter of the nipple at the base of the nipple

 

After your nipple has swollen, measure the diameter of the nipple at the base of the nipple. Be careful not to include any areola in the measurement. Gently lay a ruler onto the areola next to the base of the nipple so the measurement lines are visible when looking straight at the breast. This can be tricky so some women find that doing it in front of a mirror or using a smart phone in selfie mode is helpful.

Select a shield size 2-3mm larger than your nipple diameter

To allow the nipple to move freely within the flange while pumping and to avoid any pain or discomfort (or worse – blisters!) from rubbing, select a shield size that is 2-3mm larger than the diameter of your nipple. For example, if your nipple measures at 18mm, you would want to try the 20mm shield. It’s important not to go too large either because excess areola can be drawn into the flange, causing discomfort, pain, or even constriction of milk flow.

Signs your breast shield may be too small

  • Painful rubbing of nipple in flange.
  • Nipple not moving freely inside of flange.
  • Redness of the nipple.
  • Whiteness of the nipple and/or a white ring around the base of the nipple.
  • Little milk is being expressed.
  • General discomfort while pumping.

Signs your breast shield may be too large

  • Excess areola is drawn into the flange or even up and around the nipple. Note that a small amount of areola may enter the flange for some women; however, it should never be uncomfortable or painful.
  • Sensation of pulling and/or pulling pain.
  • Nipple is pulled to the end of the flange.
  • Shield falls from the breast while pumping.
  • Little milk is being expressed.
  • General discomfort while pumping.

Size that is just nice

  • A properly sized breast shield should be very comfortable.
  • You should barely be able to feel it while pumping.
  • Just a gentle tugging sensation on the nipple and nowhere else.
  • You should not see any excess areola being drawn into the flange
  • Should not feel a pulling sensation or pain while using your breast pump.
  • After your pumping session, your nipple should be free of any redness or whiteness.
  • Pumping should be pain-free

 

Additional factors impacting breast shield size

Although the above instructions provide a good indication of the size of breast shield you will need, there are few things to consider:

  • Every woman’s body responds differently to pumping. It is possible your measurements before pumping might change during pumping, therefore we suggest taking measurements of the swollen nipple 5 minutes after pumping.
  • Your measurements might be different throughout the day. For example, you might be fuller in the morning after going a few hours without pumping and/or feeding at night, warranting a larger size. You might also be smaller in the evening after consistent pumping or feeding throughout the day.
  • You might be larger at the beginning of a pumping session, and smaller after some milk has been expressed.
  • Your measurements might change after your milk supply is well-established (about 10 weeks postpartum).
  • One breast may need a different sized breast shield than the other.

However, you should not follow this guideline blindly because the info graphic merely relies on nipple diameter only. In addition to nipple diameter, you should also consider the following factors:

  • Check how your nipple moves while pumping.

The nipple should move freely and it should not rub the side wall of the flange. You may see a little bit of areola gets pulled, but not the whole areola. And your nipple should not hit the back wall of the breast shield.

  • Comfort

Even if you think you already choose the best breast shield size, but you feel uncomfortable / painful while pumping, that means something is not right. Try to size up or down. Nipple redness / or sore feeling after pumping is also an alarm that you may need to choose different breast shield size.

  • Effectiveness of pumping

If you feel you breast is not emptied after pumping, you may suspect that you don’t use the correct breast shield size (note: various factors can affect this, breast shield size is just one of possible reason).

  • Breast tissue / elasticity

Some women has a very elastic tissue so that the skin will get pulled easier. In this case, it is possible that pumping makes nipple get elongated so much until it hits the back wall of the flange. For this case, using breast shield with longer ‘tunnel’, or using smaller insert in bigger breast shield may help.

 

Nipple Ruler

We also found Nipple Ruler by pumpables.co

Simply print it out, fold along the line, and carefully cut out the circles.

The nipple ruler works on both US Letter and A4 paper sizes. Make sure you select “full size” or “100%” in your print menu (don’t “scale to fit”). You can also print it on larger sizes like US Legal or A7, but you might have to trim off the extra

 

At the end of your pumping session, use the circles to measure the diameter of your nipple at the base. You should select a size that is snug, but not constricting, around your nipple.

Here’s another Nipple Ruler we found from MayMom

If you have more questions or need further help with breast shield sizing, reach out to a Certified Lactation Consultant. In the long run, it’s worth taking the time to determine the breast shield size that’s right for you. You’ll benefit by maximising your pumping sessions so you can get back to what matters most – the little one you’re pumping for!

Reference
https://pumpables.co/measure/
https://spectra-baby.com.au/measuring-nipple-correct-flange-size/
https://www.medelabreastfeedingus.com/article/143/breast-shield-sizing:-how-to-get-the-best-fit

Posted on Leave a comment

Sore Nipples

nipple pain after breastfeeding

Sore Nipples 101

Ouch! Breathe. It’s not that painful… but when the baby starts to latch, OUCH! Many mummies, including myself, have had the experience of having sore nipples while breastfeeding. It is a frequent complaint from mummies, and some assume it’s an inevitable part of the nursing experience. But lactation experts agree that pain is a sign that something isn’t right.

It is common to feel some discomfort when the baby first latches on, especially in the first days after birth before the milk has come in. This type of soreness will usually ease up after the first few sucks, especially after the milk lets down and flows freely.

Babies are born with a strong sucking reflex, but they have to learn the mechanics of breastfeeding. At the same time, you are learning the mechanics of positioning, supporting the breast, etc. While some babies seem to come into the world knowing just how to breastfeed correctly, more often it is a learning process for both of you.

Nipple soreness will usually begin during the first few days of nursing, will peak on the fourth or fifth day, and then ease off each day after that. Soreness should lessen greatly on days 7-10, and by the time the baby is 2 weeks old, nursing should be pain-free.

What are the causes of sore nipples?

Difficulty latching on

This is by far the most common cause of sore nipples. A good latch should feel like tugging and pulling but not painful.  A poor latch from a baby is when the baby has to pull or suck your nipple hard into her mouth.  Your nipple is then too far forward in the baby’s mouth and it pinches your nipple against her hard palate, causing pain.

For breastfeeding to be comfortable, your baby needs to have the entire nipple and part of the breast in his mouth. The nipple needs to be near the back of her mouth where the palate is soft. This good latch is more likely to happen if the baby latches on with his head tipped back so that her chin is pressed into the mother’s breast and her nose is away from the breast. Of course, every baby and every breast is a little different, so you may need to adjust the positioning to find what works best for both of you. If your baby doesn’t gape to take in your breast, don’t pull your nipple out. Instead, break the suction by gently inserting your finger into the corner of her mouth and above her tongue. Take her from your breast and start again.

 

Here’s a video from NHSChoices

Tongue-tie
If your baby has a tongue-tie, her tongue will be attached to the bottom of her mouth. If she can’t move her tongue much, she may not be able to draw full feeds from your breast. The signs will be that she can’t latch on well to your breast and keeps slipping off. She will be feeding often, but not putting on enough weight. See a doctor to check for treatment recommendations.

Adjust without unlatching
If your baby latches on, and it hurts, you’ll know something is wrong. Sometimes mothers are advised to stick a finger in the baby’s mouth, unlatch him, and start over. The problem with this approach is that it’s very frustrating for the baby: every time he starts nursing, he’s taken off the breast. Some get so frustrated they refuse to nurse or begin clamping down on the nipple. It also puts you at the risk of more nipple damage if the baby latches on incorrectly repeatedly.

What you can do is to adjust when the baby is latching,

  1. Wait for the baby to open its mouth by tickling the baby nose with your nipple.
  2. Count to 10 for the baby to readjust.
  3. If you still feel tight and the position is wrong, flange the baby’s upper and lower lips out and hold the baby’s jaw for about 10 sec.
  4. Holding down the jaw for about 10 seconds is to make sure the baby’s jaw is in the position and doesn’t go back up.

Feed as soon as you spot a hungry cue
A very hungry baby isn’t going to have much patience and may try to grab at your nipple, causing more pain. Feeding the baby as soon as he seems hungry will make it easier to work on getting a good latch every time.

Use your milk to heal cracked, bleeding or blistered nipples
Express a little milk onto the nipple and let it air-dry there.  Apply an ice pack just before you feed the baby to temporarily numb the nipple as you latch the baby on. One piece of good news: breastfeeding nipples generally heal very quickly once the cause of the damage (such as a latch problem) is resolved.

Thrush

If your nipples are sore after a spell of pain-free feeding, and you feel burning, shooting or stabbing pains in your breasts, you may have thrush on your nipples. Thrush is a fungal infection that sets in when organisms that naturally exist in your body spread out of control.

Your doctor can prescribe an antifungal treatment for you and your baby. If you have thrush on your nipples, it will also be in your baby’s mouth, whether or not you can see it. You’ll both need to be treated at the same time, so you don’t keep passing the infection between you.

Dermatitis or eczema

If your nipples are inflamed and itchy it may be a sign of dermatitis or eczema. This can be caused by creams, lotions or soaps that irritate your skin. Swimming in chlorinated swimming pool water can also sometimes cause sore, itchy nipples. Wash your breasts with plain water alone, and see your doctor if your symptoms don’t improve.

Teething
If your baby has tender gums due to teething, she may change the way she feeds. If her tongue isn’t down and forward enough to take in a big mouthful of breast, she may end up biting your nipple. Help your baby to gape and keep her tongue forward by touching her lips to your nipple and then moving her quickly onto your breast as she responds. Older babies sometimes keep their mouths open but pull their tongues back after they have gaped, so you’ll have to move fast.

Breastfeeding during pregnancy
Your nipples may be tender if you are breastfeeding and pregnant again. Your nipples may only feel tender in the early days of your pregnancy, or they may only feel sore towards the end of your third trimester. If your nipples get really sore, you can try using a purified lanolin ointment or cream to soothe them.

Soreness from your bra or breast pads
If your nursing bra is too tight, it will put pressure on your already sore nipples. Some breast pad traps air and often will cause your nipple’s condition to worsen. Choose breast pads from natural materials which will help your skin breathe.


How to make yourself feel better

Have a towel on standby

Once the baby is done nursing you will want to gently dry your breast of any leftover milk. Gently clean the nipple and dry it. Breast milk is a great healer but it’s best to keep it dry to keep any form of bacterial away.

Air your nipple

Bring down your bra flap, use a nipple shell or even using a hairdryer on a low setting after each feed.

Apply modified anhydrous lanolin

After nursing, apply lanolin cream to help ease off some of the soreness. Surface dampness can contribute to soreness and cracking if the nipple remains moist after nursing, the same way your chapped lips get worse if you lick them. Applying lanolin can help keep the skin soft and pliable, which helps breaks in the skin heal without forming a hard scab which will break open each time the baby-nurses.  Don’t use soap on your nipples as it can dry the skin. Bathing with clear water is all you need to keep your nipples clean.

Use Nipple Butter

Nipple butter helps keep your nipples soft and supple. It also helps to moisturise and heal your sore nipples.  It’s completely safe for the baby, so keep it with you at all times.

Breast Pads

Some breast pads and plastic linings in bras don’t let your skin breathe and they trap the moisture. Choose pads made from natural materials. I like to use disposable ones as I feel that they are cleaner and I can just change and feel fresh at any time of the day. Be sure to put a couple of sets of breast pads in your diaper bag and you can change your breast pads on the go!

Nursing bra

Getting a comfortable bra will help you improve your breastfeeding experience.  If your nursing bra is too tight, it will put pressure on your nipples and cause pain. Try wearing a bigger bra.

Gel Pads

Have one set in the fridge! So that after an intensive feeding, you can put them on for some cooling relief it brings!

Don’t Give Up

I promise it will get better! It’s about learning together with your baby. Before you know it, you will be feeding like a pro! It always makes me sad when mothers quit nursing because of soreness. The long-term benefits of breastfeeding far outweigh the short-term pain. It really is worth hanging in there – ask any nursing mother, and she’ll tell you she’s glad she didn’t give up when the going got rough.

 

Reference

Teresa Pitman Jul 8, 2011

BabyCentre Sore Nipples, February 2013

Breastfeeding Basics, Anne Smith, IBCLC September 2013