Last updated: 19 May 1997
To contribute to this collection, please send e-mail to the address given above, and ask me to add your comments to the FAQ file on breastpumps. Please try to be as concise as possible, as these FAQ files tend to be quite long as it is. For a list of other FAQ topics and how to get the archived discussions, tune in to misc.kids or misc.kids.info.
Please DO send copies of this document to anyone who might be interested. The only limitations are:
A) You must copy the whole document, without making any changes to it.
B) You do NOT have permission to copy this document for commercial purposes.
The contents of this document are copyright (c) 1992-1997, Beth Weiss, solely to prevent unauthorized for-profit use. This document represents many different opinions, but does not represent Baylor College of Medicine or its opinions in any way.
For a list of other FAQ topics, look for the FAQ File Index posted weekly to misc.kids, misc.kids.info, misc.kids,pregnancy, misc.answers, and news.answers, or see it on the web at http://www.ultranet.com/~pyewackt/kids/faqindex.html.
Summary: This file contains helpful ideas about expressing, storing, and feeding breastmilk for your baby, including comments on available breastpumps
Logistics of Pumping (storage, thawing, transporting)
How to encourage a let down
General pump buying and getting started advice
Survey of Successes
Nipple confusion survey
Which pump should I buy?
How to store pumped milk
Transporting pumped milk
How long milk can be stored
Using pumped milk
When to start pumping
Don't put too much milk in a bag (2-3 oz in a 4 oz bag), since it will expand when freezing. Most people close the bags with twisty ties; some use tape. Label the bags with the amount in them and the date.
Misc. points people made:
The Milk Banking Assoc. of N.A. guidelines, 1993 strongly discourage the use of polyethelene bags.
The titres of secretory IGA antibodies to E.Coli polysaccarides decrease by as much as 60% when milk is stored in them, dramatically reducing the amt. of protection available to the infant. Some vitamins are also lost with polyethelene. They are difficult to seal, puncture easily, and are therefore an increased risk of contamination.
Warning: don't microwave breastmilk.
Some people prepared the bottles at home, others let the daycare provider make them. Some people take all of the dirty bottles/nipples home and sterilize them, others have the daycare provider do it.
Nursing Mothers' Counsel recommends defrosting milk by moving it to the refrigerator 8 - 12 hours before it will be used. Heat and vigorous shaking can damage milk cells. Milk should be defrosted with water no warmer than body temperature and gently swirled to mix the cream.
You prorate exposure: that is, if the milk was at room temperature for two hours coming home, it has used 1/3 of its life and can only have 32 hours in the fridge now.
Note added in 1998 by Paula Burch: as a result of new research, recent guidelines for the storage of breastmilk are vastly more forgiving. Please consult the La Leche League or a lactation consultant for more detailed information. Freshly pumped human milk is now considered safe to give to the baby, if carefully and quickly refrigerated, for up to 5 to 7 days of refrigeration, so it is no longer considered necessary to freeze milk pumped on Friday for use on Monday. (I never myself refrigerated milk for seven days, but my baby never developed diarrhea in spite of my saving Friday's milk for Monday or even Tuesday in the refrigerator at the daycare. One might wish to be more careful with babies who have other health poroblems, however, just in case.) How long frozen milk can be used depends on the material you store the milk in and on your own freezer. Typical guidelines say up to 6 months at 0 degrees Fahrenheit (-20 Celsius), but if the milk picks up bad odors from other foods in the freezer, even well before that time, it is likely to be refused by the baby. I personally have had success in freezing milk for up to six months in both aa top-of-the-fridge freezer and a side-by-side refrigerator freezer.
BTW, I was always told to defrost it under COLD running water, then warm it up with hot.
Do you think it would be possible to put in a plea to women not to use a pump if it hurts? Anytime you feel pain during nursing or pumping, there is some possibility of tissue damage. Nipples should be treated gently at all times. If a pump hurts, stop using it or turn down the suction.
I've seen too many women lose their milk supplies using inadequate pumps and I've seen some brutally damaged nipples from pumps that don't have an automatic release cycle.
I believe that the important factor in comfort in using a breastpump is the steadiness with the force of the suction is increased. A jerky increase in suction is more uncomfortable than a smooth one. Sensitivity in women's nipples varies dramatically. Some don't mind even the least smooth-operating breastpump, others find even the smoothest somewhat uncomfortable and the others unbearably painful.
One of the most important points in using a pump is getting a good let-down first. This reduces discomfort and increases yield dramatically. Stimulation of the nipples is one way to achieve this.
Hint (which will make more sense once you are already nursing): To get the most milk as quickly as possible when pumping, ensure you have a let-down. This may mean thinking about your baby nursing or it may mean direct nipple stimulation (the latter for me). It makes pumping very much easier and faster. In addition, if you massage the breast while pumping (sort of "pushing" the milk towards the nipple and squeezing gently), you'll get a better yield.
I have one question to the more experienced pumpers. Is it common to have three or four letdowns in a pumping session? Until I realized that there was a lot more coming, I would stop much too soon.
I never got much milk from pumping, even with the Medela. I know woman that could get more milk hand pumping then I could with the Medela. I didn't have a very easy let down reflex. On the plus side, I didn't need to wear breast pads either.
On one hand, I would suggest waiting until after you deliver, to see what level of pumps you need, but the Gerber pump was really great to have around to help with some early breast feeding problems (inverted nipples, clogged ducts, an infant that didn't want to suckle at first, etc.).
One thing to note is it will go though a lot of cycles, whether hand-powered or electric, so the mechanism (especially springs etc.) will have to be robust. The pump we used for the oldest had springs break regularly: it was supplied with spares, but not enough.
Ease of cleaning/sterilizing is also important. The metal bits can't be chemically sterilized, and electric bits can't be submersed. I used three different types of pumps (MagMag, Gerber, and Medela). The all pumped the milk directly into bottles, and all three used a standard bottle thread. You don't need to use the ones they include. The magmag bottle had a wide rimmed cup, but the lid had a smaller opening that you attached the pump too. A standard bottle will fit it.
But--if you use a standard bottle that is *larger* than the one supplied with the pump, i. e. has more cubic volume, more surface area that the vacuum has to act on, or any slight misfit causing vacuum leakage between bottle and fitting, you get less suction so it takes longer to pump. Medela gets around this problem by those little thing-a-ma-jigs that pop up and down during the suction cycle. So it doesn't matter what size of bottle you use with Medela. But with the other cheaper pumps if you are using rechargeable batteries you are going to get a reduction in suction over what you would have with non-rechargeable batteries, because the voltage is slightly lower. I was always running them with the suction wide open, and couldn't spare any more loss of suction. I did notice a difference with bottles that didn't come with it, so I just washed out the ones that did come with it and transferred the milk into the Playtex nurser type of bottles.
If you give birth in a hospital, one thing that might be worth looking into ahead of time is whether the hospital sells breast pumps. The reason that I mention it is that some insurances will cover the cost of a breast pump along with other medical expenses billed from the hospital. The hospital I gave birth at sold a battery powered unit which turned out to be okay. Since I got the pump while I was a patient at the hospital, the charge for my pump was included with along with the rest of expenses incurred during my hospital stay and my insurance covered 90% of the cost. I didn't plan it that way, but it happened that way and was nice for me to get a pump at a cheap price. So that way it's not so bad if the pump doesn't work out.
Many professionals (lactation consultants, etc...) will only recommend the Medela or Ameda Egnell pumps because they are the ONLY ones that regulate pressure, and test for pressure. Some other pumps (such as the previously mentioned MagMag, as well as Gentle Expressions, and the like) can do some SERIOUS breast tissue damage - and there is really no way to tell if your breasts are going to be sensitive to a pump until it is too late.
The two most frequently mentioned elements for successful pumping were:
Of the 16 responses I collected:
"More important, I think, is to have a private room where you can use a rental pump."
"It's important to have a private and relatively comfortable place to pump at work and to figure out when the best time of day is for your milk supply."
"My biggest recommendation is to find a comfortable place to pump."
"To make pumping easier I rent a Medela Lactina pump and keep it in my office during the week and take it home over the weekend. At home I have a small Medela pump which runs on either AC or batteries. The small pump cost about $80.00 and was worth every penny. It included most of the parts I needed for the rental pump."
"The best thing that you can do is to rent a good pump."
"My best advice is to get a good quality pump!"
"I would also recommend buying a double pump attachment.... When I used a small battery pump, it would take me about 30 minutes to pump about 4 ounces. And, it would hurt most of the time. With the good pump (and pumping both breasts at once), I was able to pump 6 ounces in 10 minutes."
"Double pumping was a lifesaver, though you feel like a cow hooked up to a milking machine. It would generally only take me 20 minutes to get to the pumping station, double pump, wash the stuff and get back to my desk."
"... (generally) breastfed babies don't drink very much expressed milk while away from their mothers. They prefer to "hold out" as much as possible and nurse when they get back together with mommy."
"BEFORE you return to work... start expressing some of your milk."
"Expressing AND nursing will increase your milk production."
"IMPERATIVE. Make sure Jr. takes the bottle (of expressed milk, of course) BEFORE you go to work."
"If you are breastfeeding YOU ARE STILL EATING FOR 2. DO NOT start dieting"
"...Drink, drink, drink... and then drink some more!"
"By all means practice with the pump before you head back to the office."
"Another thing I did to alleviate anxiety was give the sitter a can of powdered formula to keep an hand for emergencies."
"...the most important advice I can give: STOCKPILE, STOCKPILE,STOCKPILE!"
"Definitely follow the suggestion of one of the previous replies and bring extra pads and keep an extra top handy(or use a sweater)."
"When I am using a pump, moving the flange from one area to another helps increase my yield. Also, vary the amount of pressure placed on the flange, from light to pressed strongly against your chest wall. If you are single pumping, try using your other hand to curl your fingers around the outside edge of your breast and press inward to see if you can increase the flow."
In my opinion, the issue of supplementing should be looked at in a broader perspective that incorporates other portions of your life. I could have got enough milk to avoid supplementation by pumping in the evenings and on weekends. However, that would cut down on my sleep, time with my kids, and time to do other urgent tasks, and I didn't deem it worthwhile. Some women can produce vast amounts of milk with little apparent effort, and for them, avoiding supplementation takes almost nothing extra. However, for anyone that is struggling unhappily to get enough to cover their infant's needs, I'd suggest stepping back and taking a look at *all* your goals and priorities, and deciding if it really matters. If it does, there are lots of things you can try to increase your supply, the efficiency of your pumping, and the arrangement of your baby's feedings. If it doesn't matter, get what you can comfortably get in the time you have available, and use formula sparingly to fill in the difference.
Women differ a lot, and it is important that first time pumpers know it. I've got a friend that can hand express 8oz in 10 minutes every 2 or 3 hours. On the other hand, I've never got 8oz in a single session, regardless of the method used, and I've got friends that get even less than I do. Don't compare yourself, but if you can, do try different methods/ techniques to see if you can get more.
Pumping takes practice, patience, and persistence. Try not to get discouraged, don't compare amounts with other women, and constantly look for new techniques. I tried lots of different pumps, timings for pumping, and methods. For example, my current pump can double or single pump, and I am pretty good at manually expressing. I try different combinations of each, both at the same pumping "session", and at separate sessions. On average, I usually double pump for about 10-12 minutes, then switch to single pumping when I'm not getting much anymore. Single pumping allows me to massage with the other hand which allows me to get more. On times when I haven't had a good let down (and there are a lot of those times...) I might then do some manual expression at the end, as I find it is the most effective in getting the milk out. I've also tried single pumping first, or double then single then back to double, or alternating a manual expressed "session" with a pump session, etc. Different things work different times, and I'm always finding new little tricks.
The people who responded to my poll on breastpumps must be wondering what happened to the results. Sorry, it took a while to analyze. This is the original poll:
>1. What kind of pump did you use?
> a. Large Medela (not Lactina, but the heavy cast-metal
> in clear acrylic one)
> b. Medela Lactina
> c. Nurture III
> d. inexpensive (<$100) electric pump
> e. battery-operated pump
> f. manual pump
> g. hand expression
>(If these categories don't fit, tell me so.)
>2. How long were you able (or have you been able so far) to express
>enough milk to meet your baby' needs without supplementary formula?
>Weeks? Months? Not at all?
There was so much data that came in!
The hypothesis I was testing was whether women who use inferior pumps end up supplementing with formula earlier than women who use a better pump. The reason for the hypothesis is that it seemed to me that those I spoke to who used the heavy-duty Medela Classic seemed to be able to do without supplementation longer than the ones I knew who were using the small, cheap, and to some women, painful ones. Many women seem surprised when they learn that my friend with the nine-month-old is still pumping successfully.
I cut out all the answers such as "two months so far", so I could average the numbers. Two months in this example would skew things badly if that particular baby ends up without supplementation until 9 months of age!
a. Large Medela................avg 9.5 n=7
b. Medela Lactina..............avg 6.4 n=7
c. Nurture III.................avg 9 n=2**
d. inexpensive electric........avg 6.6 n=7
e. battery operated............avg 6.9 n=11
f. manual......................avg 9.6 n=8
g. hand expression.............avg 7 n=1**
** = not enough to consider significant, even without statistical testing
The large Medela and manual pumps are superior to anything else. I expected the large Medela to win, but not the manual pumps. Are manual pumps better, or is it only that only women naturally blessed with high milk production and easy let-down use them? You decide. The Lactina and smaller electric or battery-operated pumps are not as good as either. (Six months looks like a fine average, but there were plenty in there who had to give up at four weeks!)
Several women strongly agreed that the large Medela (not Lactina) was essential to their success with pumping. Several other women disagreed with the whole idea that brand matters. Make what you wish of this!
Other factors that are important in success of pumping, and some miscellaneous notes: (Some of these are much more important than one's choice of pump)
1. The day-care provider's commitment to helping you breastfeed.
This is an odd one--it's not harder to use breastmilk than formula, after all, even easier when you consider there's no mixing or sterilizing for the day-care provider to do. (Other factors must enter into unwillingness to support breastfeeding.) No matter how much you pump at work during the day, it hurts your efforts if you get home with full breasts, only to be told, "Oh, I just fed him." It's hard to get as much at a feeding as the efficient baby could get for him or herself.
2. Trouble with letdown
If you don't get a good letdown, you'll end up with sore nipples and almost no milk pumped. This may mean tickling your nipples, thinking lovingly of your baby, or whatever. Many women can't find anyplace other than the ladies' restroom to pump. That MUST reduce letdown, I think! Yuck. Employers ought to provide a decent room, closet, or whatever for this, for those who don't have offices.
3. How many feedings you have to pump for. Three times a week is obviously much easier than five. My friend said, early on, that she got 350 mls from pumping on Monday, but by Friday that was down to 250 mls. The weekend, with frequent nursing, built her supply back up every time.
4. Double pumping (both sides at once) Which is more significant, cutting the time in half so you don't get bored or have to hurry back to your work, or the increased prolactin levels Medela claims that research shows? Could be either or both. You can double-pump with either of the Medelas and the Nurture III, and some women buy two MagMags so they can use one on each breast.
5. Having someone else pumping along with you. It's easier to remain committed to something that people around you think is normal.
6. Time to try pumping two or three times during the day, instead of only at lunchtime. Most women can pump only 4 to 6 ounces at a time, judging from my mail. I've gotten up to eight, but 6 is more usual.
7. If you're on maternity leave (such as it is), going to go back to work, but haven't gone yet, you should be pumping after feedings and stockpiling what you get in the freezer. You'll be glad you did!
8. Gaskets! If the gaskets get worn, your production will appear to be going down--call the company to get new ones! (This was on a Nurture III.) Someone added: I had to make sure I cleaned the gaskets directly with undiluted dish-detergent. If I washed them with soapy water or diluted the detergent in any way, they would not get clean enough. They would stick to the bottle and not seal correctly and then I couldn't let down. I had to put the detergent directly on the gaskets to get them clean enough for me.
9. Note: costs vary dramatically for the same pump. For example, my MagMag (which I hated) was $40 in the Right Start catalog. Someone told me she paid $63.00 at Oh Baby in San Diego.
10. So how much milk do you get when you pump? The most interesting part of this posting to anyone who has just started with this business!
"....here's the executive summary of what I would tell someone who
wants to express at work:
* get support
* get educated
* if it's what you really want, don't give up"
|> 1. My baby first had bottles
|> a. before three weeks of age
|> b. between 3 and six weeks of age
|> c. between six weeks and 3 months of age
|> d. after 3 months
|> 2. (Before the age of three months) my baby
|> a. did not have troubles with breastfeeding due to nipple confusion
|> b. did have troubles with breastfeeding due to nipple confusion
|> 3. (After six weeks of age) my baby
|> a. refused to take a bottle later on
|> b. took a bottle without any problem later on
|> 4. (After six weeks of age) my baby
|> a. did
|> b. did not
|> wean him/herself to a bottle without being encouraged to do so.
Standard advice is to avoid introducing bottles before a baby is 3 weeks old, to avoid dooming efforts to breastfeed by nipple confusion, but then to be sure to introduce a bottle before the baby is six weeks old to ensure that the baby WILL take a bottle when it's important for him/her to do so. Another issue is that it's often very upsetting for mothers committed to the benefits of breastfeeding when their babies decide to forgo the breast altogether in favor of bottles; the question is whether the time of first bottle introduction has any effect on this.
Hypothesis 1: bottles introduced too early (usually taken as < 3 weeks after the baby is born) lead to the trauma of nipple confusion (which often dooms breastfeeding).
Results: 33 had bottles in first 3 weeks. Of these, 9 had nipple confusion, or 27%. Out of a total of 60 babies, 10 had nipple confusion, or 17%. Only one respondent of the 27 (or 4%) whose first bottle experience was after three weeks indicated nipple confusion when the first bottle was after the first three weeks; that baby had the first bottle after 6 weeks but before 3 months, took a bottle later, and self-weaned to a bottle (i.e., gave up the breast without being encouraged to do so).
Conclusion: Bottles introduced too early often do lead to nipple confusion, and nipple confusion can almost always be prevented by avoiding bottles in the first three weeks. However, there is a 2/3 chance of avoiding nipple confusion even if you allow bottles to be introduced too early. (I personally do not consider these odds good enough to allow early bottles, when you consider how horrible the nipple confusion experience can be.) There will now be some interest in comparing first-week bottles to bottles first introduced at two weeks, etc.; someone *else* may volunteer to take that poll. :-) ============================================================
Hypothesis 2: bottles should be introduced by the age of six weeks to prevent total rejection of bottles later on, such as when the mother returns to work.
Of the 14 babies who rejected bottle-feeding, 6 (43%) had their first bottle before three weeks, 1 (7%) between 3 & 6 weeks, 3 (21%) between 6 weeks & 3 months, and 4 (29%) after three months. Of the 41 which did not reject bottle feeding (not counting 5 respondents with non-a, non-b answers to question 3), 25 (61%) first had bottles < 3 weeks, 7 (17%) first had bottles 3-6 weeks, 6 (15%) first had bottles 6 weeks to 3 months, and 4 (8%) had their first bottles after three months.
+ bottles -bottles
< 3 wks. 43 % 61 %
3-6 wks. 7 17
6 wks.-3 mos 21 15
>3 mos. 29 8
Conclusion: Babies first given bottles before the age of 6 weeks had a 23% chance of rejecting bottles altogether in favor of the breast; babies first given bottles after the age of 6 weeks had a 50% chance of rejecting bottles altogether. Introducing bottles by 6 weeks does help, but is far from fool-proof.
Hypothesis 3: Date of bottle introduction affects whether the baby later rejects the breast altogether in favor of bottles.
13 babies weaned to the bottle (rejecting the breast altogether) without being encouraged to do so by their mothers. In most but not all cases this was traumatic for the mother who felt that it was best to continue breastfeeding. Of these, 6 (46%) had early bottles at < 3 weeks, 1 (8%) had its first bottle at 3-6 wks, three (23%) started bottles at 6 wks to 3 mos, and 3 (23%) first started bottles after three months. Of non-self-weaners, 27 (60%) had <3wks, 7 (16%) 3-6 wks, 6 (13%) 6 wks-3 mos, and 5 (11%) > 3 mos.
Conclusion: the ones who self-weaned to bottles were more likely to have had first bottles late! This is a surprising result, and, as with the two questions above, I have run no statistical tests to determine whether the figures are significant.
Overall conclusion: Bottles should be introduced after three weeks but before six weeks. Secondary conclusion: it would be interesting to fine-tune a poll to see whether three weeks is indeed the lower cut-off for these effects, or if it's actually two weeks or even one. Caveat: Polls such as this one in which not everyone in a population answers the questions are frequently untrustworthy due to self-selection; a better approach would be to apply the poll to everybody who gives birth in a certain hospital, for example. HOWEVER, these are the only solid figures of any sort that are available anywhere, as far as I can tell, so the results are the best ones in existence.
Medela's new carrier kits are purple and green and look like exercise bags. (I'm not kidding.) You can put the Lactina in one compartment and use the other for your lunch as well as your expressed milk. Retail for $25 - $30.
I bought an insulated bag with an ice pack, and used that to carry milk back and forth. I found it kept frozen milk frozen for more than 3 hours. So, if you're just taking the milk from your office right home or the daycare provider, you probably don't need a "special" carrier.
(To find the nearest Breastpump Rental Stations/Retailers, Nursing Bra Retailers, Baby Scale Rental & Specialty Feeding Product Locations, Baby Carrier/Diaper Bag Retailers and Breastfeeding Specialists)
Medela, Inc. (800) 435-8316 or (815) 363-1166
Ameda/Egnell, Inc. (800) 323-8750 or (312) 639-2900
Bailey Medical Engineering (Nurture III and Double-Up) (805) 528-5781
Marshall Electronics, Inc. (MagMag, Marshall-Kaneson)
Lincolnshire, IL 60069
Healthteam (Gentle Expressions)
627 Montrose Ave.
South Plainfield, NJ 07080
White River Concepts 1-800-824-6351 (There is not currently information on their pump in the file, but I will add comments if they are sent to me.)
Motherwear, Complete Catalog for the Nursing Mother, (800) 950-2500 or (413) 586-3488
Right Start's phone number: 1-800-LITTLE-1
For more information about pumping and storing your milk, contact your local LLL leader. If you don't have a local phone number, contact LLL headquarters at (312) 445-7730, 9-3 Central time.
Many of the small manual battery pumps are available at drug stores and Toys R Us.
part two: which pump?
back to Paula's personal home page
back to Paula's personal home page
This page has been accessed
time(s) since February 3, 1998.
Sitemeter says different visitors to this site since May 5, 1999.