Improving access to appropriately fitted equipment to support mothers expressing breast milk. A project toolkit. (v2 June 2025)

Please open in PowerPoint desktop to
ensure hyperlinks and embedded
items work
Improving access to
appropriately fitted
equipment to support
mothers expressing
breast milk.
A project toolkit.
v2. June 2025

The aim of this toolkit developed by Health Innovation Wessex is
to tell you everything you need to know about this project and
provide you with the tools and resources to implement a similar
project in your own healthcare setting.
The toolkit is split into two handy sections, the first focuses on the
background to the project and research evidence, whilst the
second covers tools and materials to help you implement your
own version of the project.
Section 1
• Background
• Research evidence
• Project goal and measure
ment
• Colostrum is “liquid gold”- R
eal-world application
• Initial project feedback
Section 2
• Education Resources
• Optimising the Expression of Breastmilk and the Importance of Flan
ge Sizing – Staff Training Webinar
• Flange FITS™ Guide
• Expressing breastmilk patient information video
• Tools and materials
• Nipple sizing tools
• Flange purchasing
• Patient information on breast pumps
This project, and the toolkit, is
based on three pillars:
Evidence-based
training for staff.
Parent education.
Toolkit aim and contents
Access to tools/
resources.

Section 1
• Background
• Research evidence
• Project goal and measurement
• Colostrum is “liquid gold”- Real-world application
• Initial project feedback

Background
Funded by NHSE South West, Health Innovation Wessex (HIW) is supporting the spread of a
quality improvement project initiated in University Hospital Southampton (UHS). The project
focuses on equity of access to appropriate equipment for expressing maternal breastmilk and
was initiated following a mother sharing her experience of expressing breastmilk for her
premature baby and subsequently developing mastitis.
Research shows correctly measured and fitted flanges on breast pumps increase yield of
breastmilk, reduce mother’s discomfort, and could reduce the incidence of developing
mastitis.
Currently, there is a low level of knowledge and nipple measurement is not standard practice.
Trusts only stock a standard size which is far too large for the majority. Mothers are required to
buy the correct fitting flange, which disadvantages those from low-income families.
This project is working across Wessex to support staff training, develop education resources for
parents, and improve access to the correct equipment through NHS procurement. At time of
writing, this project is currently being evaluated, however, early data shows the percentage of
pre-term infants receiving breast milk in the neonatal unit has increased by 11%. By receiving
breastmilk, children benefit from improved long-term health. Maternal breastmilk has been
shown to reduce the incidence of premature babies developing necrotising enterocolitis.1
This toolkit should help you to implement a similar project in your own healthcare setting.

Research evidence
This project is informed by scientific evidence of the impact of flange sizing on the expression
of breastmilk. Of particular influence is the article 'Flange Size Matters: A Comparative Pilot
Study of the Flange FITS™ Guide Versus Traditional Sizing Methods.' This was published in
the Journal of Human Lactation by Lisa A. Anders, Jeanette Mesite Frem, and Thomas P.
McCoy.
Research found that the standard fit flanges had significantly less milk output and less
comfort when compared to the newer small-size fitting.
The paper concluded that:
“Flange fitting is a process that should be individualized to the patient and may
require a trial of one or more sizes during a pumping session. Smaller sizes
determined using this individualized process and starting with nipple tip
measurement may be used without compromising milk output or comfort.”
You can read the article in full here.
Citation: Anders LA, Mesite Frem J, McCoy TP. Flange Size Matters: A Comparative Pilot Study of the Flange FITSTM
Guide Versus Traditional Sizing Methods. Journal of Human Lactation. 2024;0(0). doi:10.1177/08903344241296036

Project goal and measurement
Impact statement:
Through training staff, educating women, and supporting trust procurement, more
women will have free access to appropriately fitted equipment to support expression
of breastmilk, thus contributing to patient experience.
Measured by…
• Number of staff trained using training resources developed.
• Number of women accessing an educational video resource developed to
support expression of breastmilk.
• Number of stock items issued outside of 24mm standard stock item.
• Qualitative feedback from staff trained.
• Qualitative feedback from women supported to express.
• Increase in breastfeeding data captured in Thames Valley and Wessex Neonatal
Operational Delivery Network dashboard on preterm optimisation elements.
For this project, we developed an impact statement and considered how we would
measure the success of the project. We have included these below for inspiration
and would recommend developing your own impact statement when
implementing this project and thinking about what success would look like in your
setting.

Colostrum is “liquid gold”- Real-world application
Colostrum is the first milk your body produces following birth. It is thick, nutrient-rich, and high in antibodies.
Colostrum helps to protect babies from infection and supports their immune system. It helps their digestive
system to develop and helps prevent jaundice. It is particularly beneficial for premature babies, helping
reduce the risk of necrotising enterocolitis, and is a recommended element of preterm optimisation (
Saving Babies Lives V3).
These photos were taken at
University Hospital
Southampton, and both pots
were filled after 15 minutes of
pumping just 48hours after
giving birth. Prior to swapping
to the correct flange size, the
colostrum gathered barely
covered the bottom of a
single pot.

Initial project feedback
“I love the patient education video - the information is so clearly explained and visual. I am really
excited to use this within our Trust and I think it will hugely improve the outcomes for our families who use breast pumps.”
– Infant Feeding Lead.
“I have never had my nipples measured for flange size or had any idea that adjusting part sizes and fits could have
such an impact. The video highlights all the key information that I was missing from my pumping journey. It is so friendly
and easy to understand, Amber is clear and the information is detailed and relevant. Having the measuring tools on the
pumps and on the wards would be so helpful, even if a baby appears to be breastfeeding well, I feel it would be
helpful for women to know what size their nipples measure at! Just in case they need to start pumping. I went through 4
flange sizes and am sure none of them were right! Seeing an actual lactating women use the sizer and pump is really
helpful and the video is a good length for a very tired new Mum to process. Thank you for this, I feel it will make such a
difference to people in a similar position to me. Had my 3rd baby had been my 1st, there is no way I would have
breastfed, it was so painful and challenging. Having more information about how to pump pain free will help more
women to extend the time the breastfeed. Thank you ”
😊
– Maternity and Neonatal Voices Partnership, Hampshire and Isle of Wight.
“I’m really excited about the flange sizing project and the resources available within the toolbox to better support staff
and the parents of babies in our NICU. This is already helping more families to meet their goals and more babies to
receive milk made just for them.”
– Neonatal Infant Feeding Lead Nurse.

Section 2
• Education Resources
• Optimising the Expression of Breastmilk and the Importance o
f Flange Sizing – Staff Training Webinar
• Flange FITS™ Guide
• Expressing breastmilk patient information video
• Tools and materials
• Nipple sizing tools
• Flange purchasing
• Patient information on breast pumps

Optimising the Expression of Breastmilk and the Importance of
Flange Sizing – Staff Training Webinar
This staff training webinar is aimed at those who support mothers to express breastmilk on the
neonatal unit (NNU), transitional care unit (TCU), postnatal ward, or community. The
objectives are to raise awareness of the importance of flange fitting and provide the skills to
deliver this care. This practice is a recommendation of newly published research. This
demonstrates that when women are correctly fitted with a breast pump flange, they will
achieve a higher milk yield and experience less discomfort . The webinar was produced in
collaboration between University Hospitals Southampton, Health Innovation Wessex, and
NHSE South West.
For healthcare professionals: To complete the training on NHS Learning Hub (previously e-
Learning for Health), please visit their website. A certificate is available upon completion of
the training: https://learninghub.nhs.uk/catalogue/FlangeSizing
If you are not a healthcare professional: If you wish to
view the training but cannot access NHS Learning
Hub, you can view the webinar on the following slide.

Optimising the Expression of Breastmilk and the Importance of
Flange Sizing – Staff Training Webinar (recording)
https://vimeo.com/1044675244
If you are a
healthcare
professional,
please access
this training
through NHS
Learning Hub
(previously e-
Learning for
Health):
https://learnin
ghub.nhs.uk/c
atalogue/Flan
geSizing

Flange FITS™ Guide
This infographic provides a quick
overview of flange fitting. This is taken
from the Flange FITS™ Guide
developed by Babies in Common (full
version available in here or
embedded below).
©Copyright Babies in Common 2023 Jeanette Mesite Frem, IBCLC.
Reproduction permitted with attribution. April 2023.
Flange FITS™
Guide

Expressing breastmilk patient information video
https://vimeo.com/1048952527
This patient information
video was produced to
support women to
measure themselves for
the correct flange size
and offer advice on
good expressing
technique.

Nipple sizing tools
For this project, we commissioned engraved laser cut
nipple sizing tools, which can be sanitised with
antibacterial wipes after use in the same way as other
breastfeeding equipment.
These tools which were given to trained staff and
attached to breast pumps at secondary care locations
to allow women to measure themselves. The breast
pumps also feature stickers with QR codes on which
takes patients to the Wessex Healthier Together website
and a video on how to find their size and express
breastmilk.
The size guides provided on the tools are: 10mm, 13mm,
15mm, 17mm, 18mm, 19mm, 21mm, 22mm, 24mm.
For this project, the supplier was YEAH laser. They have
since made
these nipple sizing tools available on their website for
ease of ordering.
Staff were given
clips to attach the
tools to their
lanyard.
Available from Amazon, £26.99 for 300 at time of writing
Tools were
attached to breast
pumps using
retractable tethers.
Available from AliExpress, 82p per tether at time of writing

Flange purchasing: Medela, Spectra, and Lansinoh
For this project, the supplier was Ana Wiz. The flanges can be bought in smaller quantities from their
website. They can be bulk bought in packs of 24 for £70.80 + VAT* by emailing sales@anawiz.com
and using the product codes below:
The above flanges are compatible with Medela, Spectra, and Lansinoh pumps. They can be
used with Ardo pumps when purchased with additional kits highlighted on the following slide.
*correct at time of writing
Maymom MyFit Shields
(Classic Series)
MP012-F10-BULK-24 10mm Shields
Maymom MyFit Shields
(Crater Series)
MP012C-F10-BULK-24 10mm Shields
These flanges are recommended for women who are
engorged and may struggle with the classic flange

Flange purchasing: Ardo
For Ardo pumps, the kits below are available from Ana Wiz by emailing sales@anawiz.com and
using the product codes below. They come in packs of two but are individually wrapped so can
be separated.
Alternatively, women in the community who don’t have access to the correct sized hard-shelled
flanges may use silicone flange inserts with Ardo pumps, such as the below examples from Amazon:
• Nuliie (£9.99 for a pack of 10 at time of writing)
• Luxemum (£9.99 for a pack of 10 at time of writing)
*correct at time of writing
Each kit costs £12.50 + VAT*
and contains:
2 × Shields
2 × Tilted backflow
protectors
4 × Duckbills
2 × Membranes
2 × Silicone tubing
2 × Tubing connectors
Maymom Pump Double Kit
Compatible with Ardo Breast
pumps (2 Pack)
AR001.B-2F10.4in1 10mm Shields

Flange purchasing: Testing kits
A flange fitting kit on the ward allows staff to
accurately assess mothers’ correct flange sizes while
reducing wastage of plastic and equipment.
Once fitted using the testing kit, the mother can be
given her own new set of flanges.
It is imperative that this kit is cleaned appropriately
and thoroughly in between each patient use. The
necessary steps are detailed in the embedded SOP
that can be localised to each unit.
Used items that are returned or no longer needed
can be recycled in the trust according to your local
environmental sustainability practices.
SOP
Flange fitting and
disinfection SOP
version 1.0

Healthier Together Wessex
Sticker PNG
(HIW website)
Sticker sheet (HI
W website)
Patient information on breast pumps
Stickers with QR codes were produced and attached to breast pumps. These direct patients to
the Wessex Healthier Together website, which features a patient information video with advice
on expressing milk for the individuals using the pump. The stickers used in this project were
printed by Inkdrop Signs and Graphics in Southampton, however, other providers are
available.
Sticker templates are available below. People within Wessex should use the Healthier Together
QR code. Those outside Wessex should use the other stickers which will send you directly to the
patient information video on Vimeo.
Breastmilk
expressing sticker PNG
Breastmilk
expressing sticker sheet PDF
Outside Wessex
Sticker PNG
(HIW website)
Sticker sheet
(HIW website)
Vimeo breastmilk
sticker PNG
Vimeo breastmilk
sticker sheet PDF

Feedback
We’d love to hear what you think about our toolkit!
Please take a moment to fill out our feedback survey
here: https://forms.office.com/e/49hDAekkfj
This would help us improve our provision in future and
provide better experiences to mothers and babies.
If you have any questions about the toolkit or the project,
please contact Holly Green by emailing
holly.green@hiwessex.net.
We also invite you to get in touch and share any
additional resources or experiences related to this project
to improve the toolkit for everyone.
Please scan to provide
feedback!

Health Innovation Wessex
Innovation Centre
Southampton Science Park
2 Venture Road
Chilworth
Southampton
S016 7NP
E: enquiries@hiwessex.net
@HIWessex
T: 023 8202 0840
healthinnovationwessex.org.uk

Improving access to appropriately fitted equipment to support mothers expressing breast milk. A project toolkit. (v2 June 2025)

More Related Content

Similar to Improving access to appropriately fitted equipment to support mothers expressing breast milk. A project toolkit. (v2 June 2025)

More from Health Innovation Wessex

Recently uploaded

Improving access to appropriately fitted equipment to support mothers expressing breast milk. A project toolkit. (v2 June 2025)