January 20, 2020
Choosing a breast pump can be a confusing task. Since approximately 2012, many insurance companies in the USA have been mandated to supply breast pumps, and many mothers do not have a choice of breast pumps unless one is purchased in addition to what her insurance supplies. Many WIC agencies (Special Supplemental Nutrition Program for Women, Infants and Children) also supply pumps to breastfeeding mothers.
Breast pumps can be single sided and manually operated (hand pumps). Most women choose pumps that express both breasts at the same time (double-electric) using electricity, disposable batteries, or a rechargeable battery. These double-sided electric breast pumps tend to be more effective at breast drainage and raising the prolactin level as compared to single-sided hand pumps1. Some pumps only allow mothers to have control over the degree of suction, while other pumps also allow mothers to control the speed of the suction cycles. Many pumps have a ‘stimulation phase’, which is a fast, low-suction cycle. This is designed to encourage a milk ejection reflex. Once the milk begins flowing, it is typically recommended that the mother switch the setting to the ‘expression phase’, which has a slower cycle and increased suction for more efficient and complete emptying.
‘Hospital grade’ pumps are expensive multiuser pumps with good quality motors. The FDA does not have a definition for ‘hospital grade’. These pumps have a closed system, meaning that milk cannot flow from the pump collection kit into the pump itself, preventing contamination from one user to another. There are several newer pumps on the market that are closed systems with excellent motors at a reasonable price, making the cost of renting a hospital grade pump often unnecessary, since the more expensive rental pumps have not been shown to be more effective than these newer higher quality pumps on the market. An exception may be for mothers of premature infants, since some of the newer hospital grade pumps have patented cycle patterns for mothers with premature infants. There is not a great deal of research on the true efficacy of these patented cycles.
Every mother who uses a pump needs to learn how to use her breast pump properly, to prevent nipple trauma and loss of milk supply due to insufficient drainage. This involves making sure that the breast shield, which is the flange into which the breast is placed, is properly fitted. Most breast pumps offer different breast shield sizes, and some pumps have soft flexible shields that are one-size-fits-all.
The instructions on how long to pump at what suction level is also very individual, depending on the reason for pumping and maternal physiologic factors such as speed of letdown and milk supply. It is recommended that mothers use the highest comfortable suction strength. Just as we encourage every new mother to be observed while nursing to ensure proper latch and good milk transfer, a mother who is relying heavily on pumping for milk expression would benefit from being observed by a lactation professional while pumping to ensure safe and effective pump use.
- Eglash A, Malloy M. Breastmilk Expression and Breast Pump Technology Clinical Obstet and Gynecology 2015 58(4) 855-867