Things to look at when Choosing and Buying a Pump

A mother should not have to choose between having a career and being a mother. By pumping breast-milk at work a mother will keep providing her baby with the ultimate sustenance, help maintain her supply so they can breastfeed when together, and she will remain intimately connected with her baby in a way only she can.

The breast pump market offers a bewildering range of devices to choose from. Grouping them together one can choose from: manual or hand pumps that generate suction manually (silicone and squeeze handle types); single or double electric / battery-operated pumps; and hospital-grade electric pumps. The "bicycle horn" style manual pump is NOT recommended to collect breast milk.

Things to consider when buying a pump: How old is baby going to be when mom returns to the work force? How much can she afford to spend on a pump? Other considerations are portability, noise level, ease of use, ease of cleaning, ease of assembly, the number and complexity of parts to assemble, automatic or manual suction, release cycle, instructions accompanying the pump, comfort (mom’s) and efficiency.

Most current breast pumps are based on a study by Einar Egnell et al. (1956). This study has established that a total negative (vacuum) pressure of about 220 to 230 mmHg (millimetres of mercury) is typically produced when a baby is breastfeeding and the maximum pressure is usually held for less than one second.

Pumping is not supposed to hurt. Factors influencing comfort is how the pump works, looking at amount of suction applied (measured using mmHg), the length of time that maximum suction is applied before it is released (ideally 1‒2 seconds, which determines the cycles per minute), and how well your breast fits into the pump flange and tunnel (size in mm). Nipple damage is most likely to occur when the initial phase of creating suction lasts longer than one to two seconds. Breast pumps with automatic cycling will usually do so at a rate of 40 to 60 cycles per minute. Breast pumps with small motors which can take from 10 to 50 seconds to reach maximum vacuum, and may cycle fewer than 10 times per minute, this exposes the nipple and areolar tissue to increased trauma from prolonged unrelieved suction.

Ideally, when the pump is operating, the nipple is drawn into the tunnel of the funnel and the areola is gently squeezed against the flange. In a good fit, the nipple moves freely within the tunnel. If the pump funnel is too small the nipple will be dragged along the sides of the funnel tunnel, causing friction, damage, and pain. If the funnel is too big, a portion of areola tissue may be drawn into the tunnel and there is often a ring shape imbedded into the breast after pumping. With an either too big or too small funnel, pumping may also be painful, even at very low suction, a mother may have a difficult time removing milk and experience on-going trouble with plugged ducts due to the ducts not draining well. It is not always possible to determine the best funnel size without actually pumping. Note that the size of the nipple, not the breast size, determines the funnel size.

Efficiency is another way of rating breast pumps, and this can also go hand in hand with comfort. An efficient pump will stimulate a milk-ejection reflex (MER) or let-down and remove milk thoroughly and quickly, important for employed mothers with time constraints.

A big step forward in the development of breast pumps, are pumps that can drain both breasts at one time, better known as double-pumping. A mother who “lets down” easily with a good pump can be finished in as little as 10 minutes (rather than at least twice that time for pumping one breast at a time). Double-pumping has also been shown to stimulate a greater release of prolactin than single pumping.

Research lead by Professor Hartmann resulted in the development of a pumping pattern called 2-Phase Expression, or the “Natural Expression Pumping”, an attempt to more closely simulate what a baby does during a breastfeeding session. This research showed that a breastfeeding baby has a characteristic sucking pattern that begins with rapid, high frequency sucking and changes abruptly to a slower suck/swallow pattern at the time of milk ejection (or let-down). Hartmann’s research also demonstrated that a breast pump using two-phase cycling is more effective in breast milk removal than single-cycling breast pumps. During the “Let-Down” mode, the pump mimics a breastfeeding baby’s initial rapid nursing action that stimulates the milk ejection reflex (MER) or “let-down” and quickly begins milk flow. Once milk begins to flow, moms can switch to the second mode, called “Expression”, which mimics the baby’s longer feeding cycle in which slower, deeper suckling helps to maximize milk flow in less time.

When pumping time is limited and larger milk volumes are needed, or if a mother needs to pump to increase her milk supply, the hospital-grade rental pumps are the preferred option. These full-size, automatic hospital grade electric pump, have a suck-release cycle that is closer to the pattern of a baby than the continuous suction of some smaller pumps. Many women report they are very efficient and quiet, although not quite as portable. These are usually rented (although the equipment that attaches the mother to the pump must be purchased) and cost varies.

Note that breast pumps are considered "single-user" products, because of the risk of contamination (there is a chance that milk can be aspirated into the pump mechanism, which cannot be sterilized), it should thus not be borrowed or shared. Manual pumps that can be autoclaved are an exception.

Since breast pumps are personal hygiene products any of the pump parts that are exposed to the previous user’s milk may harbour viruses that were present in the mother’s system. Baby could become ill if these viruses are passed to him/her. Cytomegalovirus (CMV), Hepatitis, Human Immunodeficiency Virus (HIV) and Human T-cell Leukaemia Virus Type 1 (HTLV-1) are some of the most common viruses that are transferred through breast milk. The potential health risks may be increased if the previous user experienced a fungal infection (thrush), cracked nipples or bleeding nipples.

Closed system breast pumps have a barrier in between the milk collection kit and the pump mechanism, while an open system does not have a barrier of any kind. This can cause many unwanted problems, including contamination of precious breast milk. Since any open system does not contain a barrier between the milk collection kit and the pump mechanism, the milk is exposed to the outside air, which is drawn through the pump system. This allows impurities that may be found in the air such as dust, smoke, pet dander, pollution, airborne bacteria, and viruses to contaminate the breast milk. There is also a possibility that milk particles can be sucked into the pump’s tubing, as well as parts of the pump that cannot be cleaned and mould can begin to develop. Keeping the pump at chest level will help to protect against aspiration of milk into the pump mechanism. Mom can prevent impurities in air contaminating pumped milk by noting where she pumps.

To summarize:

A breast pump should simulate, as realistically as possible, a baby feeding at the breast. Research has shown that normal healthy newborns achieve up to 220 mmHg of suction while breastfeeding and have a suck-swallow cycle of about 40‒60 times per minute. The sucking is a little faster when they first begin breastfeeding and a little slower after the let-down reflex occurs. The pump should meet these criteria. The funnel (the part of the pump that fits over the breast) should cover the areola to support the tissue and the opening should fit loosely around the nipple and allow the nipple to stretch freely into the nipple tunnel during the suction phase of the cycle. Most pumps have several sizes of flanges available to accommodate different sizes of nipples. Pumps come in different price ranges, however, when a mother is highly motivated, any pump type can be successful in any situation.

- ASSISTING THE EMPLOYED BREASTFEEDING MOTHER by Kathleen G Auerbach, Journal of Nurse-Midwifery Volume 35, Issue 1, pages 26–34, January-February 1990.

- The Milk Memos: How Real Moms Learned to Mix Business with Babies-and How You Can, Too by Cate Colburn-Smith, Andrea Serrette (2007).

- Breastfeeding and Human Lactation, Jan Riordan, Karen Wambach 2009.

- J Hum Lact. 1996 Sep;12(3):193-9. The effect of sequential and simultaneous breast pumping on milk volume and prolactin levels: a pilot study. Hill PD, Aldag JC, Chatterton RT.

- J Hum Lact. 1996 Sep;12(3):193-9. The effect of sequential and simultaneous breast pumping on milk volume and prolactin levels: a pilot study. Hill PD, Aldag JC, Chatterton RT.

- Pediatrics 113 (2) 2004, "Ultrasound Imaging of Milk Ejection in the Breast of Lactating Women" Donna T. Ramsay, Dip; Jacqueline C. Kent, PhD; Robyn A. Owens, PhD; and Peter E. Hartmann, PhD.

- Journal of Human Lactation 19 (2) 2003, "Response of Breasts to Different Stimulation Patterns of an Electric Breast Pump", Jacqueline C. Kent, BSc, PhD; Donna T. Ramsay, DMU, PGDip; Dorota A. Doherty, PhD; Michael Larsson, MBA; Peter E. Hartmann, BRurSci, PhD.

- Journal of Human Lactation 18 (4) 2002, "Effect of Vacuum Profile on Breast Milk Expression Using an Electric Breast Pump", Leon R. Mitoulas, PhD; ChingTat Lai, MSc; Lyle C. Gurrin, PhD; Michael Larsson, MBA; Peter E. Hartmann, PhD

- Am Fam Physician. 2003 Dec 1;68 (11):2201-8. Returning to work while breastfeeding. Biagioli F.

#pump #ecpress #backtowork

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