Archive for the 'Breastpumps' Category

Mothers Who Forgo Breastfeeding for Pumping

by Nancy Mohrbacher, IBCLC

Not long ago, one of the mothers in my private practice arrived at my door with her husband. Like many new parents I see, they beamed with pride at their robust seven-and-a-half-month-old son, Bradley, who was growing and thriving on mother’s milk alone. Unlike most other new mothers I see, however, this one had chosen seven months earlier to give up on breastfeeding and to pump and give her milk to her baby by bottle.

During my two years in practice, I have worked with a number of women who decided to give up breastfeeding in favor of pumping and giving their milk by bottle. Because there is so little information available on this option, I decided to conduct a survey of these mothers, as well as several women in other areas of the US whose names La Leche League gave me for this purpose. I hope that the experiences of these ten mothers will be useful to other mothers considering this choice.

Why Mothers Choose This Option

The ten mothers in the survey gave a variety of reasons for their decision to forgo breastfeeding for pumping:

  • the baby was nipple confused and fussed at the breast (2),
  • the baby refused to latch on,
  • the baby was rough with the breast during breastfeeding,
  • the baby was unable to breastfeed due to a physical problem (one baby had a cleft palate, the other baby was unable to breastfeed due to the combined effects of prematurity, Down Syndrome and a congenital heart defect),
  • the baby refused to go back to breastfeeding after a lengthy temporary weaning,
  • the mother had sore nipples and found that pumping did not hurt,
  • the mother found pumping and bottle-feeding more suited to her lifestyle with her first baby (who would not latch on) and chose to do it again with her second,the mother felt uneasy with the act of breastfeeding.

How They Did It

These mothers used a variety of pumps. Eight mothers used a hospital-grade automatic electric breast pump; two used a hand-held battery-operated pump. Three mothers used Ameda/Egnell’s Lact-E, one used Ameda/Egnell’s Lact-E Lite, three used Medela’s Classic, one used Medela’s Lactina Select, and two used the Evenflo hand-held pump. One of the mothers who used the Evenflo pump said she went through two pumps during the 21 months she expressed.

Although double-pumping would clearly have been a time-saver for these mothers, not all of them chose to do so. Seven of the mothers surveyed double-pumped, while three (including the two using the Evenflo pumps) pumped one breast at a time. The mothers who single pumped spent an average of 27 minutes at each pumping (ranging from 20 to 30 minutes per pumping) 4.6 times a day (ranging from 4 to 5 times per day) for an average of 124 minutes of total pumping daily (ranging from 113 to 135 minutes). The mothers who double pumped averaged 17.3 minutes at each pumping (ranging from 9 to 40 minutes) an average of 5.3 times per day (ranging from 4 to 7) for an average of 90 minutes of total pumping daily (ranging from 55 to 160 minutes).

The number of pumpings per day varied, depending upon whether the mothers were in the process of increasing their milk supply or it they were getting the amount of milk they wanted. Those who began pumping during first few days after birth, averaged 6.3 pumpings per day during the first week (ranging from 4 to 12 times per day). This number dropped to an average of 5.5 pumpings per day once their milk had increased and they were getting enough milk to sustain their babies.

Some of these mothers breastfed before they began pumping, while others did not. Three began pumping after a period of effective breastfeeding, one after three-and-a-half months (due to a medically indicated temporary weaning), the second after six weeks (due to nipple confusion), and the third after four days (due to sore nipples). The remaining seven mothers breastfed once or twice or not at all. Of these seven, four began pumping on their baby’s first day, two on the second or third day, and one on the sixth day.

Results

Milk yield varied among the mothers. When the mother with the highest milk yield (96 oz per day) was eliminated (she purposely stimulated a larger milk supply than her baby needed in order to freeze extra milk), the average milk yield was 37 oz. (ranging from 21 to 55 oz.). Surprisingly, the mothers reported that the amount of milk pumped at each session was unrelated to time of day and correlated most closely with the length of time since the last pumping. The mothers who did not get up at night to pump reported that the first pumping in the morning yielded the most milk, but those who pumped during the night reported that the amount of milk pumped stayed consistent from pumping to pumping.

There was some variability of milk yield based on the type of pump used. The two mothers who single-pumped using the Evenflo pump reported average daily milk yields of 26 oz. and 32 oz. (with 5 and 4.5 daily pumpings respectively). The three mothers using the Ameda/Egnell Lact-E had average daily milk yields of 96 oz., 55 oz., and 32 oz.(with 7, 5.5, and 4 average daily pumpings respectively) . The mother using the Ameda/Egnell Lact-E Lite had an average daily milk yield of 32.5 oz. (with 5 daily pumpings). The three women using the Medela Classic reported average daily milk yields of 46 oz., 42.5 oz., and 42 oz. (with 4.5, 6, and 6 average daily pumpings respectively). The mother who used the Medela Lactina Select had the lowest average daily milk yield of 21 oz. (with 6 daily pumpings).

The mother with the highest milk yield pumped between 6 and 8 times per day from birth and produced about 96 ounces per day. Her goal was to freeze extra milk for her baby, who had multiple health problems, and when she returned her pump, she had enough milk frozen to sustain him for another six weeks of exclusive human milk feeding.

The Mothers’ Feelings

The mothers surveyed pumped and bottle-fed their milk for an average duration of 6.7 months (ranging from 2 to 21 months) and shared many positive comments about their experience. They all felt good about giving their babies the health benefits of human milk and agreed they would recommend pumping and bottle-feeding to others, as they considered it a better alternative than formula-feeding. Several of the mothers said that “it was important for the baby to get the milk” but felt it didn’t matter how he or she got it. One mother said her husband found it reassuring in light of the publicity on dehydration and breastfeeding to know how much the baby was getting. Another, who had pumped with a previous child and chose not to initiate breastfeeding with her second, commented on how well it worked within the context of her busy lifestyle. One mother said she was glad not to have to breastfeed in public and appreciated that anyone could feed the baby. Several mothers also acknowledged the extra time commitment involved, one referred to pumping and feeding as “taking double time.”

Some mothers were criticized by others; some were praised. Several said they were called crazy for pumping and bottle-feeding. One was told she was “a saint.” Several mothers expressed a plea for support and understanding. When her baby wouldn’t latch on in the hospital, one mother said the nurses and lactation consultants tried to discourage her from pumping and bottle-feeding. The mother said she was finally able to relax and feel good about her decision when a lactation consultant in private practice told her that it was okay. Another mother put it this way, “Every mother has her own way, which needs to be respected.”

If a mother is considering pumping and bottle-feeding, the information gleaned from these mothers’ experiences may help her decide if this option is workable for her. The mothers surveyed were able to successfully establish and maintain a full milk supply for many months by pumping on average 6 times per day at first and then settling into a 4-6 times per day routine. The mothers who single-pumped averaged 26.6 minutes of pumping 4 to 5 times per day (average total: 124 minutes per day), while the mothers who double-pumped averaged 17 minutes of pumping about 5 times per day (average total: 90 minutes per day). When sharing this information, however, be sure to note that these mothers were selected for this survey because they had been successful at long-term pumping. Mothers unable to establish a milk supply through pumping were not included, so not all mothers may achieve these same results.

Are Used Breast Pumps a Good Option? Issues to Consider

by Nancy Mohrbacher, IBCLC

What new mother wouldn’t like to save money on a breast pump? That’s why we are often asked: “Do you have used breast pumps available?” Some mothers have friends or relatives offering to lend them a used pump. Is a used pump a good option?

Open Systems vs. Closed Systems

Some mothers mistakenly assume that because rental pumps are safely shared by mothers that it is also safe to share purchase pumps. This is not true. Rental pumps and purchase pumps are designed differently. The collection kits (the bottles and tubing that attach to the pump) used with the rental pumps are designed so that the milk never touches the working parts of the pump that are shared with other mothers. This is considered a “closed system.”

Most purchase pumps, for example Medela’s Pump In Styles, DoubleEase, and MiniElectric, are “open systems.” This means that the pump motor is “open” to contact with the mother’s milk particles. In a Pump In Style, for example, the breastshield (the part held against the breast) is open to the tubing that attaches to the back of the shield, which is also open to the diaphragm on the pump motor that creates the suction and release. This means that an invisible mist of milk particles can travel from the shield into the tubing and back onto the pump diaphragm. The diaphragm cannot be removed or sterilized, so it cannot be cleaned well enough between mothers to insure safety. When there are milk particles on the pump diaphragm, even with a brand new set of bottles, tubing and breastshields, with every suction and release another mother’s milk particles will be blown into your milk. Even if milk particles are not visible, they can still be there. (One sure sign is mold growing in the tubing, which sometimes happens with normal use.)

Choosing a Breastpump

Not all nursing mothers need a breastpump. If breastfeeding goes smoothly and a mother chooses to take her baby with her wherever she goes (or if the baby nurses at predictable intervals so that the mother can slip out for a time without having to worry about missing a feeding), she may never feel the need for a breastpump. During my nursing years I only used a breastpump once: when my youngest was one year old and became so congested from a head cold that he could not breastfeed for an entire day. I borrowed a manual breastpump from a friend, used it several times to relieve my fullness, and went back to breastfeeding after his sinuses cleared. However, not all breastfeeding experiences go so smoothly, and not all women are willing or able to stay close to their babies. If mothers and babies are separated at feeding times or if a baby is not nursing well, an effective breastpump can make it possible for mothers to avoid the expense and health risks of formula.

TYPES OF BREASTPUMPS

What is the best type of breastpump? The answer depends upon the mother’s need. One of my roles as a lactation consultant is to help each woman select the best equipment for her situation and to give her the information she needs to use the breastpump optimally. Fortunately, there are many excellent breastpumps available today. But let the buyer beware: there are also many painful and ineffective breastpumps. Before investing in a breastpump, it pays to know what to look for and what to avoid.

AUTOMATIC DOUBLE BREASTPUMPS

An automatic double breastpump is no doubt the easiest, fastest, and most effective breastpump available. The mother just puts the breastpump’s breast shields to her breasts, adjusts the suction control to her comfort level, and turns it on. A full pumping takes 10-15 minutes, and when used optimally, these breastpumps are effective enough to establish and maintain a full milk supply even if a baby is not nursing. (If you’re a client, we can provide the specific information via e-mail on how to do this successfully.) In general, automatic double breastpumps provide suction and release at a rate of about 48 per minute, similar to a baby actively nursing. As a rule of thumb, the more suction and releases per minute a breastpump provides, the more effectively a breastpump stimulates milk supply and the more comfortable it feels.

Although automatic double breastpumps are the fastest and easiest to use, they may be more than some mothers need. They are no doubt the best choice for a mother working full time or a mother who is pumping and bottle-feeding her milk instead of breastfeeding, but they may be overkill for a mother who just wants to pump an occasional bottle for her baby.

The most commonly available automatic double breast pumps are Ameda Egnell and Medela rental breastpumps. Among rental breastpumps, different features are available among different brands and models, and one breastpump may be better suited to a mother than another. For example, Ameda Egnell’s Elite is the only rental breastpump that starts at zero suction, making it ideal for mothers who find the minimum suction levels of other breastpumps uncomfortable. The Medela Lactina Select and Ameda Egnell Elite alone feature adjustable speed, which helps trigger milk flow faster for some mothers. (See our Rental Pumps page under our Chicago Area Services section for photos and more detailed descriptions of the different models of rental breastpumps.)