Pumping Tips and Flange Sizing with Jacque Ordner of Motif Medical.

Kristin Revere and Jacque Ordner discuss finding ways to make pumping more effective, comfortable, and sustainable in the latest episode of Ask the Doulas. Jacque is an IBCLC, BSN, RN, RLC, and Motif Medical Advisor. 

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Transcript

Kristin Revere and Jacque Ordner discuss finding ways to make pumping more effective, comfortable, and sustainable in the latest episode of Ask the Doulas.  Jacque is an IBCLC, BSN, RN, RLC, and Motif Medical Advisor. 

Hello, hello!  This is Kristin Revere with Ask the Doulas.  I am thrilled to chat with Jacque Ordner today.  Jacque has many titles: IBCLC, BSN, RN, RLC.  And she is an advisor to Motif Medical. 

As a registered nurse and IBCLC, Jacque has worked with breastfeeding families in the clinic, hospital, and private practice settings.  As a mom of four, Jacque is intimately familiar with the struggles that breastfeeding families face, and she loves helping families create personalized feeding plans to help them reach their breastfeeding goals.  Jacque has developed much of her career to creating lactation, birth, and baby care educational programs that equip new parents for the journey ahead.  She is passionate about finding ways to make pumping more effective, comfortable, and sustainable. 

Welcome, Jacque!

Thank you so much!  I’m glad to be here! 

I am excited to dive into the pumping topic, especially making pumping more comfortable.  I’d love to hear your tips for our listeners. 

Absolutely.  This is something I’m really passionate about, working with families in private practice and advising Motif Medical.  The goal is to make pumping more comfortable, rather than something that we just absolutely dread.  There’s always going to be parts of it that we dread; washing parts, and all those things.  But my biggest tips are to understand, first of all, that it shouldn't hurt, and if it does, that means that we need to investigate the underlying causes of that.  Most often, it’s flange size.  We need to get the right flange fit.  Other causes could be an underlying infection, or maybe we have soreness going on with baby’s latch, and that’s sort of transferring over and being exacerbated by pumping.  But honestly, most of the time, we’re not getting that flange fit correct.  That’s usually the first place that I start. 

That makes sense.  So I know that with my own pumping and breastfeeding journey, it was difficult to find the right size.  And one breast can be a different size than the other, and trying to make that comfortable, you don’t have to just grin and bear it.  There is so much more that you can do, such as find a lactation consultant like yourself to help with that journey. 

Yes!  And what’s really exciting is over the last, I would say, five to eight years, maybe, we have seen more of a focus on sort of just looking at nipple sizes and saying, okay, maybe this size 24 that comes in the box as “standard” isn’t really standard.  People are surprised to find out that flange sizes that sort of just came when we started working with pumps when they were invented – that wasn’t based on science having to do with human nipple sizes.  It was really science having to do with dairy animals.  And last time I checked, most of us don’t look like dairy animals when we’re talking about our anatomy.  It makes a lot of sense that we really need to revisit that topic, and thankfully, there is a lot of new information emerging. 

Something I’m really excited about with Motif is we are taking a look at all of our flange sizing guidance, and you will see it’s a big process to change everything that comes in the box and to change all of the instructions about how to get your flange size.  But that is something that Motif has been willing to take on, and we are changing all that guidance to more closely align with the newer information that’s coming out.  And that information really is that most people’s nipples are smaller than 24mm.  They need a smaller flange size.  So we’re trying to adapt to that and provide moms what they need to be comfortable without having to jump through all these hoops. 

So we’ve got this new flange sizing sort of criteria that we’re working with or instructions that we’re providing to parents, and that is you want to stimulate your nipples.  You want to get them to perk up, be everted as much as possible.  Sometimes we have nipple shapes and sizes that are a little bit more difficult to measure and to size, and so that’s when you need to seek out that expert help.  We’ve got a couple of flange sizing tools.  One is like a measurement tape.  It’s actually on a card.  And it’s like a ruler, but with the millimeter measurements, so you can measure from one side to the other of the base of your nipple after you’ve got it everted.  The other one has the holes that you can slide over the nipple itself.  You want to use something like that to measure in millimeters, and you do want to measure both sides, like you mentioned.  And then after you have your measurement, we’re not adding as much as we used to.  The current information is that we only need to be adding maybe zero to three millimeters, where we used to say two or four, or some sources said two to five.  And we’re finding that just like when baby’s mouth is stimulating that nipple tissue, baby’s mouth is touching the nipple on all sides, so it’s no longer this, oh, no, you can’t have the nipple touching.  It’s the nipple can touch as long as we’re not seeing a lot of swelling and it’s not painful.  So we’re definitely expecting a shift in how moms are able to size themselves, as long as they have the correct information, which is sort of the most important starting point. 

Absolutely.  I’d love to hear more about Motif Medical. 

I’m so excited to work with Motif.  As somebody who loves pumping, and as a mom of four, I have nursed my babies; I have exclusively pumped.  At times, I’ve pumped for a couple of adoptions.  So pumping is something I’m passionate about personally and professionally.  And what I love about Motif is they seek the information from parents and from professionals.  They want to know what makes lives easier, but not just what products can we put out there to market and make money.  Obviously, business is business, and you have to have products that sell to make a business work, but they’re really interested in, let’s solve problems.  Let’s figure out how we can make our pumps more effective.  Let’s get this flange sizing thing figured out.  Let’s make milk storage easier.  Because the whole idea is to make pumping easier and to help families meet their breastfeeding goals.  I just love that they’re constantly seeking information from the people who are boots on the ground, in the thick of it, so they can improve their products. 

My favorite product from Motif is the Motif Luna pump.  It is an absolute workhorse pump.  It’s a pump that you could exclusively pump with.  I have exclusively pumped with it.  It’s a pump that you can build supply with right out of the gate.  And it rivals hospital rentals as far as performance. 

That’s amazing! 

It is!  When you look at the technical features, it really does rival the hospital rentals, and it’s available through insurance.  Usually, even to get the battery option is a lesser upcharge for moms than many other pumps on the market.  So I just sing its praises all the time. 

I had to rent a hospital grade pump as my daughter was in the NICU and came home, so that was challenging.  I love that there are other options like Motif’s pump that have the strength of a hospital grade pump but you don’t have – I mean, it’s pretty big and bulky.

Yeah, and the Motif Luna is – you would just be surprised at how lightweight it is and how quiet it is.  I remember the hospital rentals that you’re just like, I’m going to turn this thing on and wake my baby up in the middle of the night, and that is so frustrating.  I’m excited for the advances that are happening in this space so that families who are dealing with all these other things – we can at least make pumping a little bit easier. 

Excellent.  What are your tips for our listeners who are pumping at work? 

Oh, my goodness.  First of all, it’s not easy, and there are no magic formulas to just take out all of the difficulty.  But I like to remind families that I work with that just because something is hard doesn’t mean it’s bad.  So we can do really hard things and have really positive results for ourselves, and sometimes it’s just important when you’re in the thick of it to remember that it’s okay that pumping is hard at work and continuing to breastfeed while I’m at work, it’s hard.  Hard doesn’t equal bad, and there can be good things that are coming out on the other side.  The focus on those positives can really be motivating. 

I think the biggest tip I have is not to get so overwhelmed with what you see on social media.  Probably three, four, five years ago, that was not my biggest tip, but it has become that way because so many families are coming to me.  Moms are saying, I’m only pumping four ounces at every pump session, and I’m shouting, going yes, that’s wonderful; that’s a great amount.  But mom is dejected because she’s seeing amounts from influencers on social media that are ten ounces, eight ounces at a pumping session, so there’s this disconnect between what real, normal output is versus oversupply.  So my first tip is to know what normal is.  25 ounces a day is the average intake for a breastfed baby from one month all the way to six months when we introduce solids.  So if you’re seeing somebody pumping eight to ten ounces at every pump session on Instagram, that’s an oversupply, and you don’t need to feel like you’re doing something wrong if you're not getting those amounts. 

I would say my second biggest tip is to know that some milk removal is better than no milk removal.  So if you’re in a situation – like especially teachers that I work with, nurses – being a nurse, I remember you couldn't even go to the bathroom, let alone get in a pumping session sometimes.  Having this sort of mentality of, I’m going to do some milk removal, even if I can’t get in a full pumping session, can really be beneficial at protecting your supply.  So learned the skill of hand expression.  I can’t tell you the number of times I hand expressed into a sterile urine cup when I was working in the hospital because that’s what I could do.  I could steal away for five minutes, wash my hands.  I had a sterile container.  And I expressed some milk rather than skipping a full pumping session. 

I had to do that as a doula, as well.  I can totally relate.  At a birth, you have just a few minutes.  

Yes!  Yeah, and you’re just like, some relief.  But also, you’re at least telling your body, I need some of this milk, and it’s more protective to your milk supply. 

I think also reminding ourselves that breastfeeding doesn’t have to be all or nothing.  If you go back to work and you’re doing all the things and your mental health starts to struggle; you feel like, I just maybe need some formula.  First of all, I would highly encourage you to work with an IBCLC because sometimes there are things that maybe you’re missing.  You need somebody to look at big picture, and there are some ways to adjust things and you can meet whatever your original goals were.  And sometimes we need to adjust our goals.  And it’s okay.  You’re not unsuccessful if your goals change and you maybe aren’t producing 100% of what baby takes.  Now, it’s entirely possible to produce 100%, but sometimes we have to look at the whole big picture and decide what our priorities are.  And you’re not failing if you’re making 30%, 80%.  It doesn’t always have to be 100% of what baby is taking. 

So true.  So I would love to talk a bit more about how partners can support the pumping journey.  

I’m sure that you work with partners so much as a doula, and I always champion doulas as the coach kind of mentality with partners.  But partners can really influence so much and breastfeeding in general that they just don’t realize.  Sometimes we get focused on, I’m not the one physically feeding the baby, if mom is nursing directly at breast.  If I’m not the one physically feeding the baby, somehow I'm not bonding with my baby.  And I love to tell partners that every time you meet a need for your baby, you are creating attachment.  You can work on anticipating and recognizing their needs, and then that helps foster the secure attachment.  So every time you change a diaper, every time you bring baby to mom for a nursing session, every time you wash pump bottles, every time you give the baby a bath – you are doing something that is supporting your baby’s basic needs, and that is creating secure attachment.  So try not to be so focused on, I have to directly feed my baby to have a bond, because that’s just not true.  And then basic things for mom, too: meeting her needs is also supporting her.  Filling her water cup every time she sits down to nurse or pump.  Washing those pump parts.  Oh, my goodness.  I told my husband he never looked better to me than when he was at the sink washing my pump parts.  Doing things like asking, what can I do that would be make it easier for you right now, because as moms, sometimes we’re sitting down and we have 10,000 things running through our brains.  It looks like we’re just pumping.  It looks like we’re just nursing our baby.  But mentally, we’re juggling a lot of things.  And so having a partner that says, what are you thinking about, and what can I take off your plate that maybe has nothing to do with baby care or nothing to do with pumping, but is just something else in our lives and the management of our household that can be handled?  

And then research really tells us that being a cheerleader is so valuable for success when it comes to breastfeeding.  So no matter how your partner is feeding the baby, whether we’re pumping and bottle feeding, directly nursing, doing a combination of both – telling her that she is doing a great job, encouraging her when times are tough.  Maybe we’re dealing with cluster feeding or a dip in supply.  Helping to provide factual information, so learning about breastfeeding as a partner so you can then reinforce with factual information is really, really important for success overall. 

Excellent.  And with partner involvement, I’m always suggesting that they attend a breastfeeding and/or pumping class to be able to understand how to put a pump together or how to be that encourager and help in other ways to optimize rest for the new mom. 

Absolutely.  Even just having somebody sitting next to you in class – you’re just not going through that experience alone.  It doesn’t feel like it’s all on your shoulders.  It’s so important. 

And my final question for you, Jacque, is you mentioned that insurance covers the Motif pumps and some of the differences with your pumps, but I would love to have your tips in selecting the right pump that works for the individual based on their needs and goals.  And also, how do you figure out if your insurance covers a particular pump? 

Fantastic question!  First of all, the insurance piece is easiest, so we’ll start with that.  You can actually go right onto the Motif Medical website, motifmedical.com, and there is an insurance lookup tool where you can put in your insurance information and it will pop up different DMEs, durable medical equipment, providers who carry Motif pumps and work with your insurance.  Probably the most well known is Aeroflow.  Lots of people are really familiar with Aeroflow because they’ve got the whole things figured out.  We’ve had to send things to your house and all of that.  But there are tons of other DMEs as well who do the same thing and different DMEs might have different options based on your insurance provider.  So if you don’t find the pump that you’re looking for at one, check with another one.  That’s something I highly recommend.  And you can find even a brick and mortar store if that’s important to you to go touch the pump.  There are definitely still brick and mortar DMEs available, and the insurance lookup tool on the site will tell you all of that information if you want to go see and touch the pumps, which I’m somebody that would want to go do that. 

As far as choosing a pump, on our website, I’ve written some recent blog content really diving into this, but we divide them into really primary and secondary pumps, and that’s not like, oh, this pump is just better and this pump is worse.  It’s really more about how we’re using them.  So the Luna, because it has a really high performing motor – it’s a double electric pump.  It has the independent cycle and vacuum, so you can adjust how fast or slow it is pulling the nipple, cycles per minute or sucks per minute, versus the vacuum.  They’re independent of each other.  So you can have it going really fast with a really high vacuum or low vacuum and vice versa.  So that is kind of the hallmark of a primary use pump.  And then the other thing is that it uses traditional flanges because we tend to see better milk removal with traditional flanges.  

So then in our secondary pump category, we have things like the Motif Duo.  We have a wearable pump called the Motif Aura.  And those would be more of your secondary pumps, meaning we’re not going to rely on those for building a milk supply or exclusive pumping or maybe regularly pumping back at work.  We might have a secondary pump that we use sometimes, but we’re also going to have that primary pump like the Luna to really have those effective, efficient pumping sessions to just undergird the whole process.  

So think of your primary pump like the Luna as the one that you probably want to use your insurance benefit for, and then something portable or wearable like the Duo or the Aura, these smaller, more portable pumps.  That's something you put on your baby registry as an extra.  Really nice to have, but you want to have that primary pump as the main pump that you’re using to remove your milk. 

The other thing when you’re looking at choosing a pump is battery options.  So a lot of the primary pumps out there, like Luna, you have plug-in option, and then you have the same pump, but it has a rechargeable battery, and I can tell you in all the families that I’ve worked with, no one has ever been sorry that they scraped together a $30 upgrade fee or a $40 or $50 upgrade fee for that rechargeable battery.  So any sense that you might need to be pumping in the car or where there’s no electricity or even in a power outage – if you’re exclusively pumping and the power goes out, having that charged battery is going to be really important to your pumping journey. 

And then the other thing is knowing that flange sizing.  With Motif, it’s across the board once you figure out your flange size.  You can apply that to all of the pumps.  And so making sure that you can have an idea of what your flange size is and that as you’re shopping for pumps, make sure that that pump has some sort of option to size for you.  A lot of times, it’s a third party insert that is compatible, and that’s totally fine.  With Motif, we want you to use whatever size works for you, so it doesn’t have to be our product, but something that’s compatible that would size it for you.  So just making sure that is an option.  You don’t purchase a pump and then realize, oh, there’s not an insert available for this particular pump that fits me. 

Makes sense.  And you mentioned your website for Motif Medical, but how can our listeners and doula clients connect?  I know you’re also on social media, for example. 

We are.  Yes, you can find us on Instagram, on Facebook.  Definitely, you can even reach out.  If you go to our website and read a blog and you want to leave a comment, that’s always an option, as well.  We have great customer service.  That’s one of the things I absolutely love about Motif.  We get high marks in customer service, and those gals work so hard to make sure customers are happy.  You can always reach out to us for customer service, and that is available through the website as well, or you can call customer service directly. 

Excellent.  Thank you so much for sharing all of your pumping wisdom, Jacque, and we’ll have to have you on again. 

Loved it!  Thanks so much for the conversation!  Such an important topic.  I appreciate it. 

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