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Breastpumps 101
All breastpumps are NOT the same! When considering a breastpump, it's
important to look for one that will come as close to mimicking what
your baby does at the breast as possible. This is the difference in
what makes a pump effective and comfortable versus one that is
ineffective and may even cause discomfort or trauma to nipple or breast
tissue. There are certain criteria to consider when comparing
breastpumps. For purposes of this discussion, we will mainly focus on
battery/electric pumps but will briefly discuss the manual pumps
available on the market today as well.
Effectiveness. This for the most part translates to how well or
how often the pump cycles, or creates suction and releases it. The
healthy nursing baby will suckle 45-55 times a minute. Pumps which
cycle closer to this range tend to be more effective at yielding the
most milk as well as maintaining the milk supply more effectively. Look
for pumps which cycle at least 25 times per minute. Those with cycling
rates below 25 are often ineffective at yielding milk. In addition,
their cycles tend to be longer (as well as less) and therefore may
cause pain as the breast and nipple tissue is suctioned for too long a
period. Pumps which automatically cyle also tend to be more
effective than those which require the user to regulate the cycles,
often by covering a hole, or pressing a button or bar. Cycles which
must be user-controlled leave much to user-error.
The pump's suction strength is also important to know.
Breastpump suction pressures range from 20-650 mm Hg negative pressure.
Pressures above the high 200s often cause pain. Pressures below 150 are
reported to be ineffective at extracting milk. A breastpump that is
similar to a nursing baby creates 200-230 mm Hg negative pressure and
cycles about once every second.
Comfort. Most of the time, pumps with the autocycling feature
are more comfortable to use. Too many times, those that require the
mother to break the suction result in the suction lasting too long.
Some breastpumps also are limited to only one size breastshield.
Mothers with larger nipples and/or breasts may find these "one size
fits all" pumps uncomfortable. They may also find that the pump yields
little milk for their efforts as not enough of the breast tissue behind
the nipple is taken up into the shield; therefore the breast is not
"milked" well. Alternately, some moms require a smaller breastshield
due to smaller breasts or nipples. Look for pumps that come with a
choice of breastshields or those that have a larger or smaller
breastshield available as a separate purchase in case you should
require a different size for optimal pumping comfort and success.
Additionally, manual pumps that require a repetitive action may not be
a good idea for those with hand or wrist problems, depending upon the
type of hand action required.
Type of pumping action. - single, alternating, double.Single
pumps, whether manual or battery/electric, only pump one breast at a
time. This does not provide as good of stimulation as double pumping
and the pumping time required is also longer (twice as long in some
cases) This is still acceptable if you will only need to use a
breastpump occasionally. Single pumps are most always a good choice for
the stay-at-home mom or the mom only working part-time and needing to
use a breastpump on average once a day.
Pumps that provide alternating double suction, where the
suction is created on one side as it is released on the other, provide
more stimulation and a faster pumping time than single pumps, but not
as much stimulation or as fast a pumping time as a simultaneous double
pump in which the suction occurs on both breasts at the same time.
These alternating pumps, like the single pumps, are still good choices
for moms who don't work outside the home or who only work part time.
Simultaneous double pumps, often referred to as hospital or
professional grade pumps, offer premium pump performance. They pump
both breasts at the same time, thus cutting pumping time in half over
single pumping. Additionally, there is research to suggest that
simultaneous double pumping increases the hormone responsible for milk
production and therefore better maintains milk supply over a longer
period of time.
Pump durability. When choosing a breastpump, it's important to
have an idea of how often and how long you'll need to use the pump.
Some pumps are designed to be used infrequently and therefore have
smaller and less durable motors. Others are designed to be used
frequently and for longer periods of time and therefore have larger and
more durable motors. Don't make the mistake of choosing a pump that's
purpose and lifespan fall below your pumping frequency needs. This will
only result in premature motor wear and tear and perhaps a compromised
milk supply once the motor begins to wear out. Manual pumps, of course,
do not depend upon a motor for operation, and therefore do not pose the
problem of motor wear and tear.
Other criteria that you may want to consider: One feature that
you may be concerned about is the quietness of the pump. The larger the
pump, the more likely that the motor will be quieter. The smaller the
pump, the more likely that the motor will be louder and thus less
discreet. Manual pumps, by their very nature, are very quiet. What
power options the pump provides is also of importance. If you will need
to pump in a place without an electrical outlet, then you'll want to
consider a pump that comes ready to run on batteries or that works
manually as well as on electricity or one which has a battery as an
option for purchase or rental. How portable the pump is and how
discreet its case may also be something to consider depending upon
where you will be pumping and how often you will need to travel with
the pump. How much time you will have to pump also may factor in. If
you routinely have only a few minutes to pump, investing in or renting
a simultaneous double pump will save you time. On the other hand, if
your pumping schedule is more flexible, you may be able to get by with
a single or alternating double pump. One important note: If
pumping for a preemie or exclusively pumping, the best choice for
stimulating and maintaining a healthy milk supply is a hospital-grade
pump. Once breastfeeding is going well, you may be able to purchase a
pump. Until that time, you need every bit of help in maintaining your
supply since you don't have the benefit of your baby's help.
Pumps That Make the Grade
Single manual pumps: Avent Isis, Medela
Spring Express, Medela Harmony, Medela Pedal pump (pumping action is
done through pumping of the foot; allows for double pumping as well as
single pumping), Ameda Egnell Hand pump, or Ameda-Egnell One-Hand pump.
Note: All manual pumps require pumping action on the part of the
mother. Make sure you read the instructions thoroughly on how to
correctly use the one you choose so that the pumping action is
effective, safe, and comfortable.
Single battery/electric pumps: Medela Mini Electric or Medela Single Deluxe. Note:
These are the only pumps in this class that cycle often enough (30-38
cycles per minute) to provide enough stimulation and to be comfortable.
They are also the the only pumps in this class which automatically
cycle.
Occasional-use double pumps: Medela DoubleEase or Medela Double-Deluxe. Note:
These are the only pumps in this class that cycle above 30 times per
minutes and which provide for the automatic cycling. These two pumps
also provide for alternating suction. One other in this class with a
good track record is the Nurture 3 pump. This pump does require the
mother to regulate the cycles.
Simultaneous double pumping professional grade pumps: Any of the Medela Pump In Style line of breastpumps or the Hollister Purely Yours.
Simultaneous double pumping hospital-grade pumps: Medela Classic, Medela Symphony, Medela Lactina, Ameda Egnell SMB or Ameda Egnell Lact-E.
Pumps That Don't Make the Grade
All of the following receive poor reviews in the lactation
literature and have poor track records when used by the majority of
breastfeeding mothers: Evenflo, Gerber, First Years, MagMag, Playskool.
All of these pumps either allow for suction levels beyond what has been
determined as safe for breast and nipple tissue or cycle far below
effective frequencies (as low as 4-7 cycles for minute for some of
them). Most also require the mother to regulate the cycles.
Cleaning Your Breastpump
The following is considered adequate for cleaning of breastpump
parts if your baby is healthy:
Sterilize all pump parts that will come in contact with breast or milk
before the first use unless your parts came in a sterile package.
Sterilizing can be done in a hot dishwasher (water temperature greater
than 140 degrees) on the top rack or in boiling water for 10-20
minutes. After each use, wash these same parts in hot, soapy water and
allow them to airdry or dry them with a clean paper towel if a faster
drying time is necessary. Every third to fourth use - or at the end of
a work day - sterilize these parts again. Electric and microwave sterilizers
provide a faster, more convenient method of sterilizing breastpump
parts; however, some pump manufacturers (including Medela) do not
recommend this route of sterilization and will not guarantee their pump
parts if sterilized in this way. Any part that does not come into
contact with breast or milk does not need routine cleaning or
sterilization. This would include any tubing that may be used with the
pump. Tubing only needs to be cleaned if milk enters it. Then it should
be boiled for 10-20 minutes. Following sterilization it is also
recommended to "shoot" rubbing alcohol down through the tubing to
hasten drying and prevent mold and mildew growth. Any parts of your
breastpump which require routine cleaning and which can be separated
should be for each cleaning. Note: If you or your baby are being treated for thrush, it's recommended that daily boiling of all breastpump parts that come in contact with breast or milk take place.
Is it safe to use a previously-used breastpump?
No pump manufacturer recommends this practice. Here is what two major companies, Medela and Avent, have to say on this subject:
Medela, Inc.:
"
Many mothers have asked if they can safely sell, purchase, or use a previously
owned breastpump. Medela is concerned about the health and welfare of
breastfeeding mothers and their babies. Breastfeeding is certainly the best way
to feed your baby, and is the gold standard of infant nutrition. There is some
evidence, however, that certain serious viruses* may be transmittable through
breastmilk. For this reason, it is not advisable to use a previously owned
breastpump. Breastpumps are single-user products, or personal care items,
much like a toothbrush, and are registered with the FDA as single user items.
For safety, breastpumps should never be shared, resold, or lent among
mothers. Medela strongly discourages mothers from re-using or re-selling
previously owned breastpump equipment. The Medela Pump In Style
Breastpump has an internal diaphragm that cannot be removed, replaced, or
fully sterilized. Therefore, the risk of cross-contamination associated with
re-using a previously owned pump such as the Pump In Style cannot be totally
dismissed. Multiple use of single-user breastpump automatically voids the
warranty of the Medela product. Each mother who wishes to express milk with
a pump should use a clean, uncontaminated breastpump. This is the safest way
to eliminate any risk of cross-contamination.
Rental pumps such as the Classic‰ and Lactina pumps are made to be
safely used by repeated clients who each use their own clean personal rental
kit, therefore avoiding any possible cross-contamination. Rental pumps, when
used according to the Medela instructions, are safe to use by multiple mothers
who have their own personal kits."
Avent America:
"We at Avent America are always striving to provide
mothers with quality products at reasonable prices to help them
breastfeed longer. Research has shown that breastmilk can transmit many
contagious viruses. It is for this reason that we strongly recommend
that you NEVER use a previously owned breast pump. The Isis Breast Pump
is considered to be a personal care item and has been designed to be
for single use only. Mothers should never share breast pumps. Sharing
or using a previously owned breast pump could put you and your baby at
a potential risk for exposure to serious health risks. Some of the
viruses that can be within breast milk are: HIV - Human
Immunodeficiency Virus (AIDS) HTLV-1 Human T-Cell Leukemia Virus Type I
CMV - Cytomegalovirus When you are using a previously owned breast pump
you create the risk of cross contamination. It is for this reason that
AVENT AMERICA STRONGLY SUGGESTS NEVER USING, BORROWING, PURCHASING OR
SELLING A PREVIOUSLY USED/PRE-OWNED BREAST PUMP. Since a mother's
breast milk is the most precious gifts of nutrition/health she can give
her baby, DON'T take the chance of sharing someone else's viruses with
your baby. "
If you still find a reason to use a previously-used pump, do take some
precaution and try to replace every part which might come in contact
with breast or milk. While this will not prevent all possible risks, it
will greatly decrease them.
What if pumping hurts?
There are several things to consider if pumping is uncomfortable for you:
Is your pump of good quality? Many moms complain that
lesser-quality pumps hurt. Use the information given above to determine
if you have a good quality pump. A good pump should NOT hurt!
Do you have the pump suction or speed turned up too high?
You should only turn the suction and speed up as high as your comfort
will allow. If the pump hurts, try turning the suction and/or speed
down some.
Is your nipple centered in the breastshield or flange? A
nipple that is not centered may rub or be pinched up against the sides
of the breastshield tunnel.
Are you pumping too long? Most moms should limit pumping
to no more than 20 minutes at a time. Pumping for very long periods is
more likely to make your nipples tender. Shorter, more frequent pumping
sessions do more to increase and maintain supply than longer,
less-frequent ones anyway.
Are you using the insert piece in your breastshield (if it
came with one)? These extra pieces are designed for moms with smaller
nipples. If you have been using the insert piece, try taking it out and
see if that makes pumping more comfortable for you.
Is the breastshield large enough for your nipples and/or
breasts? Some pumps may only come with a standard breastshield. This is
designed for the "average" mother. Some moms may require a larger
breastshield in order to accomodate a larger nipple or allow for more
of the breast tissue to be accepted into the breastshield. Many pump
manaufacturers make larger breastshields which can be purchased
separately. For example, Medela makes the PersonalFit breastshield
which can be used in place of the standard breastshield. Medela also
makes an even larger glass breastshield if required by a mother. Other
breastpump manufacturers may have similar products. Check with your
pump's maker.
Are you holding the suction too long? If using a
breastpump for which you have to release the suction you may be holding
the suction for too long. Try shortening the amount of time that you
actually hold the suction; and thus make your suck/release cycles
shorter, or consider using a pump that automatically releases the
suction for you (see information above).
Could you have thrush? Discomfort with correct pumping is often a sign of thrush, especially if pumping has been pain-free before.
One Final Word
When considering the purchase or rental of a breastpump, try to
think of it as an investment in your's and your baby's present and
future physical well-being. A good quality breastpump is not a luxury
but an essential item for any mother who must use a breastpump at all!
Compare the price of an effective breastpump to the cost of infant
formula for one year (about $1200 for the least expensive form). You
wouldn't think of scrimping on a lesser-quality car seat for your baby.
You shouldn't try to get by with a poorer-quality breastpump either.
Your comfort and your success with pumping and providing your baby with
your own milk is priceless! Pumping: an act of love!
Written by: Becky Flora, BSed, IBCLC, RLC
Last revision: December 15, 2004
Sources:
La Leche League's, "The Breastfeeding Answer Book" by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC (1997).
"Helping Employed Mothers Optimize Milk Supply"
by Linda Shrago, RN, MS, IBCLC as lectured at the La Leche League
Lactation Specialist Workshop Series VIII, "Breastfeeding: Overcoming
Challenges in Today's World", October 24, 1998.
AventAmerica.com
Medela.com
Additional info at other sites:
"My Pump Isn't Working!! Help for Breastpump Users"
"Keeping the Pump Clean"
Medela breastpumps at www.medela.com
Hollister.com (PurelyYours and Nurture 111 breastpumps)
"Breastpumping Tips"
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