Choosing the Right Breast Pump

by Dr. Michele Brown

choosing a breast pumpLet's face it. A breast pump is not the most romantic, or glamorous, piece of equipment ever invented. They can be bulky and uncomfortable, hard to clean and very expensive. Even worse, when lifted out of their boxes, they may seem extremely intimidating to use on something as delicate as our breasts. Personally, I would rather spend this kind of money on a cute Kate Spade purse, or a nice pair of Gucci pumps...not a breast pump!

Does a Breastfeeding Woman Really Need One?

The answer is maybe...

It's a well known fact that breast feeding has significant benefits to both mother and baby. Four million pregnant women in America are currently employed and the majority will want to return to the workforce soon after delivery.

This should not be a deterrent for breastfeeding and therefore, it becomes extremely important for women to be encouraged to continue to breastfeed their newborns in a safe, efficient, and effective way while still carrying on their daily work lives. Since women are not available for demand feeding, it becomes vital to know how to use a breast pump so another caregiver can provide milk for the newborn.

Who Should Use a Breast Pump?

Learning how to use a pump is important in the following situations:

  • Women returning to work and not available for feeding.
  • Premature infants lacking a good suck reflex can benefit from breast milk that is pumped making it easier for them to feed.
  • Mom is unable to breastfeed due to sickness.
  • Infants having difficulty removing milk from the breast due to anatomy when other techniques to correct fail.

How Does a Breast Pump Work?

Pumping milk from the breast has its origins from the dairy industry in the 1950's by Einar Egnell. Pumps have been designed to simulate the sucking action of a nursing infant by mimicking both the suction pressure and the frequency of a baby's suckling. Pumps are designed so that the amount of pressure and the cycle frequency can be regulated by the mother.

The volume of expressed milk with a breast pump is higher compared to manual expression.

Pressure: The pump has to have enough pressure to extract milk from the breast but not so high that it causes pain and skin trauma. The pump relies on the physics of a fluid moving from an area of higher pressure to an area of of lower pressure. The breast pump creates a pressure differential with negative pressure on the breast reducing the resistance to the outflow of milk from the milk ducts of the mother, which is at a higher pressure.

Babies breast feed with a suction pressure of 50–220 mm Hg so the pumps are designed to suck at maximum negative pressures at about 220–250 mm Hg. Levels at less that 150 mm Hg are ineffective in emptying the breast and pressures greater than 220 mm Hg may cause nipple pain which will result in the mother terminating her breast feeding.

Pumps can vary in the configuration of the flange (cup applied to the breast). The smaller the cup, the more pressure is exerted over a smaller area of space.

Frequency: The other important factor is the length of time the vacuum is applied. Babies suck at a frequency of between 40 and 126 sucks per minute and pumps are designed to mimic the breast by pumping at 40–60 cycles per minute.

Selecting the Proper Breast Pump

There are so many pumps available today with countless cycle and suction settings, different sizes, power sources, single versus double set-ups and varying prices that it becomes a great enigma in choosing the right one for an individual. Important considerations in choosing a breast pump include:

  • baby's age
  • Mother's work needs (full time or part time)
  • Support from the mother's work environment
  • Mother's finances
  • Family's health insurance

Price differences can be based on the durability of the motor, length of the manufacturer's warranty, style of packaging, personal amenities, and have single or double set-ups.

Talking with a lactation consultant before you leave the hospital can help you sort through the morass of information. Many pumps are generally not refundable once used so trialing in the hospital or through a lactation consultant may be a good idea. Here are some of the factors to consider when deciding.

Price: The cost of a breast pump is approximately 41,500 for a hospital grade variety to about $150–350 for a personal use style. Prices will increase depending upon the accessories. Pumps can also be rented for from 30 to 75 dollars per month. but mothers will need to buy all the accessories which include bottles, tubing, and breast flanges for about $50. If plans are to pump for several months, it may be more economical to purchase one. Personal breast pumps in the long run are cheaper than formula which can run over 2,000 dollars a year.

Single versus double pumping: Bilateral pumping is quicker and use more powerful machines with greater cycles per minute and use more pressure to express a greater amount of milk in less time.

For women that use a single pump, the breast should be switched every 5 minutes. It may take 15 to 20 minutes as opposed to 10 minutes with a double pump.

Power source: Electric pumps produce the most milk, followed by battery operated pumps and finally hand pumps. Some pumps have car adapters. For a non-working mother who does occasional pumping, a hand pump or small battery operated pump can work well. Try to make sure the pump has a one year warranty on the motor.

Other factors: Noise level, ease of use and assembly, and difficulty in cleaning are also variables that must be considered when choosing a breast pump. Also ease of obtaining spare parts is a consideration.

Other accessories: Some pumps have more discreet carrying cases to make for easy transport. Also some packages contain gel or ice packs to keep the milk cool.

Different Categories of Pumps

Hand pumps: If you only need to pump occasionally and your milk supply is well established, a simple hand pump may be all you need. They come in two styles:

  • Cylinder pump -- Has a double cylinder set-up with suction created by pushing and pulling one cylinder inside the other. The main problem can be the gasket inside which may need replacement because of shrinkage or its inability to maintain a seal after continued use. The gasket can also harbor bacteria.
  • Hand squeeze pump -- Suction is created with a hand lever that is squeezed and released. The advantage is that it is portable, easy to use, quick to assemble, no need for electricity and is inexpensive.

Some moms experience difficulty in obtaining a good milk supply due to difference in cycling from baby's normal suck reflex. Many hand pumps have a poor suction or excessive suction. Women can also fatigue easily with continued use, especially those with wrist problems or carpal tunnel syndrome (very common in pregnancy).

Semi-automatic pumps: These pumps can be used manually, with a battery or with an electric adapter. The motor is generally small and not meant for frequent use.

The advantage is that they are portable, lightweight, small and do not require electricity. They can be double and often come with a cooler case.

The disadvantage is that they are not meant for heavy use and are not very durable. The short battery life can be expensive. The cycle frequency slows as the battery wears down. Some can also be noisy.

Personal use electric double pumps: These are automatic, light weight, durable, portable, and double-pump with controls to regulate the pressure and frequency for comfort. They generally include chill packs and storage compartments. They are run by electricity but can have battery and adapters included.

Hospital grade rentals: These are the most powerful and effective with different control settings for suction and frequency. They are the most expensive. Physically, they are large and heavy, and not meant to be portable. Therefore, there is no carrying case and no compartments for storing milk. They run on electricity. They are designed to be multi-user and you must supply your own collection kit which generally must match the pump brand.

Standards for Breast Pumps

In the United States, there are currently no standards for breast pumps to ensure the safety and quality of the products. However, the FDA does consider personal (not industrial) pumps to be used by one person only. Unfortunately, certain pumps are impossible to clean and can produce high bacterial counts making a woman more prone to infection which is a reason not to buy or share a used personal pump.

Summary

Choosing the right breast pump depends upon the individual needs of each mother. Factors to consider include the home and work situation, the amount of use, and cost factors. The assistance of a qualified lactation consultant is indispensable in guiding a new mom in choosing what works best for each given situation.

Dr. Brown, founder of Beauté de Maman, is a board-certified member of the American College of Obstetrics and Gynecology, a member of the American Medical Association, the Fairfield County Medical Association, Yale Obstetrical and Gynecological Society and the Women's Medical Association of Fairfield County. She is a magna cum laude graduate of Tufts University, completed her medical training at George Washington University Medical Center and completed her internship and residency in obstetrics and gynecology at Yale-New Haven Hospital. Dr. Brown has a busy obstetrical practice in Stamford, Connecticut and, as a clinical attending, actively teaches residents from Stamford Hospital and medical students from Columbia Presbyterian Hospital in New York.

Copyright © Michele Brown. Permission to republish granted to Pregnancy.org, LLC.