CHOOSING A BREAST PUMP

by Nancy Mohrbacher, IBCLC

Not all nursing mothers need a breast pump. 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 pump. During my nursing years I only used a pump 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 pump 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 breast pump can make it possible for mothers to avoid the expense and health risks of formula.

TYPES OF PUMPS

What is the best type of pump? 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 pump optimally. Fortunately, there are many excellent pumps available today. But let the buyer beware: there are also many painful and ineffective pumps. Before investing in a pump, it pays to know what to look for and what to avoid.

AUTOMATIC DOUBLE PUMPS

An automatic double pump is no doubt the easiest, fastest, and most effective pump available. The mother just puts the pump'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 pumps are effective enough to establish and maintain a full milk supply even if a baby is not nursing (we can provide the information on how to do this). In general, automatic double pumps 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 pump provides, the more effectively a pump stimulates milk supply and the more comfortable it feels.

Although automatic double pumps 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 pumps are Ameda/Egnell and Medela rental pumps. Among rental pumps, different features are available among different brands and models, and one pump may be better suited to a mother than another. For example, Ameda/Egnell's Elite is the only rental pump that starts at zero suction, making it ideal for mothers who find the minimum suction levels of other pumps uncomfortable. Medela's Lactina Select and Ameda/Egnell's 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 pumps.)

Comparing Medela Pump In Style to Hollister Purely Yours.
Currently there are only two pumps affordable for purchase that are comparable in ease and effectiveness to the rental pumps: the Medela Pump In Styles and the Hollister Purely Yours. The Medela Pump In Style was originally introduced in early 1996 and was the first automatic double pump affordable for most families (currently retailing at $288.50--our price: $259.65--about the same cost as eight weeks of formula). The Original Pump In Style is integrated into a black shoulder bag (so you can't buy the pump without the bag) that includes an insulated compartment to cool and store the milk and another compartment for the collection pieces. Everything together weighs about 7 lbs.

The Pump In Style Traveler (retail: $299.95--our price: $269.95), which became available in November 2000, has the same motor and pump functions as the Original Pump In Style but different features. The Pump In Style Traveler bag is a black microfiber backpack, which is ergonomically designed and very upscale looking. The motor and cooling compartment are removable, allowing a mother to leave her pump motor at work if she chooses. The removable cooling compartment gives her the option of buying an extra (called the DayCarrier Kit), so that she can take one with her to work to cool and store her milk and leave one with her baby. Unlike the Original Pump In Style, a mother can use the backpack after she is done pumping by simply removing the motor, cooling compartment and collection pieces. The interior of the bag has collapsible compartments, making it possible to configure it in the most optimal way however it's used.

Another new model, which debuted in February 2001, is the Pump In Style Companion (retail: $329.95--our price $296.95.) Like the Traveler, the motor and cooler kit are removable. The Pump In Style Companion is also made of black microfiber but has a two-piece bag design: a main bag for the pumping equipment and a Companion Organizer bag for business and personal essentials, which attaches to the outside of the main bag. It has a professional look and is ideal for the woman who would like to simplify her work day by fitting all her necessities in one bag.

The other option for purchase only is the Ameda Purely Yours from Hollister, first available in June 1998. Purely Yours is the first automatic double pump that can be powered by six AA batteries and weighs only 1 lb. It was also the first of these two pumps to offer both adjustable suction and adjustable speed (four settings ranging between 30 and 60 suction-and-release cycles per minute) to more quickly trigger milk flow. The Purely Yours is also less expensive than the Pump In Style, retailing at $204 for pump and collection units only (our price $199). The version with tote, extra bottles, and cooling elements retails for $249 (our price $239).

In 1999, no doubt as a response to the success of the Purely Yours, Medela added an optional speed control to the Pump In Style, offering five speeds ranging between 42 and 63 suction-and-release cycles per minute. Both the Pump In Style and the Purely Yours provide the same maximum suction levels (about 210 mm/hg). The Pump In Style has three suction settings; the Purely Yours has eight. Both the Pump In Style and the Purely Yours offer a one-year warranty. See our Pumps for Sale page for photos and a more detailed listing of what is included with each. The Pump In Styles and Purely Yours are excellent products. The most significant differences are as follows: The Purely Yours can be run on AA batteries and the Pump In Styles cannot (although they can be powered with a rechargeable battery pack--the Medela Power Pack--which is available for rent). The Purely Yours can be purchased with or without the tote bag and the Pump In Styles cannot.

A new addition to the automatic double pump category is the Medela DoubleEase, an exception to many of the above statements. Unlike the Pump In Style and Purely Yours, the DoubleEase does NOT provide enough suction and releases per minute to keep up a full milk supply, which is why we (and Medela) recommend it only for part-time work or occasional use. The DoubleEase provides about 35 suction and releases per minute. Also, rather than both the units sucking and releasing at the same time, as the two pumps above do, the DoubleEase units alternate suction and release. This means that when the right unit is sucking, the left unit is releasing. No one knows if this is a plus or a minus, as its effect on milk supply and pumping effectiveness have not been studied. This pump is a redesigned version of the Double Mini Electric pump that Medela introduced a couple of years ago and recently eliminated from its line. Unlike the Double Mini, though, the DoubleEase features a base motor unit that resembles the Purely Yours, and the same collection bottles and breastshields used with the other Medela kits are connected to the base unit by tubing. Also included with the DoubleEase is the CarryAll bag, which holds the pump base unit, all the collection pieces, and also features a cooling compartment with cooling elements. The retail price for the DoubleEase is $199.95. We carry it for $175.95. It features a 6-month warranty on the motor.

AUTOMATIC SINGLE PUMPS AND SEMI-AUTOMATIC PUMPS

For those wanting a less-expensive alternative, there is one semi-automatic double pump that is sold under several names--Nurture III, Double Up, and Natural Choice--and the automatic single pump, Medela's Mini Electric. These pumps are well suited to women working part-time or women at home who want a motorized pump. They provide 25-35 suction and releases per minute, fewer than the automatic double pumps, which is why they tend to be less effective at keeping up milk supply for women who pump one or more times per day or those who work full-time. Semi-automatic pumps provide continuous suction, requiring the mother to regulate suction and release by covering and uncovering a hole, or by pressing a button or a bar.

The Nurture III has the advantage of either single or double pumping and durability (it comes with a two-year warranty). If you don't mind having to manually regulate the pump's suction and release (you can generate up to 25 per minute), it is a great value at $110. A deluxe version is also available at $145 which includes a carrying bag to hold pump and cool milk, extra bottles, a cooling element, and an instructional video.

Regarding single pumps, keep in mind that single pumping takes twice as long as double pumping: 20-30 minutes compared with 10-15 minutes. Currently the best value for those wanting a small, hand-held single pump is Medela's Mini Electric which can be powered by 2 AA batteries or an AC adapter. This pump automatically generates about 30-35 suction-and-release cycles per minute, making it more comfortable and effective than the less expensive alternatives that follow.

The two main drawbacks of the Mini Electric are its noise level and its limited lifespan. Of the better-quality pumps, the Mini Electric is by far the loudest. The noise level is about the same as an electric razor, making it distracting to a baby if mother wants to pump one breast while baby nurses on the other. Regarding its durability, its previous 90-day warranty has been extended to a 6-month warranty on the motor, which is a longer warranty than most small pumps. Medela will tell anyone who asks that this pump is not designed for long-term daily use. If a mother uses it daily, she may wear out the motor before her baby is weaned. At a price of $90-$105 (our price is $89.95), most parents would rather have a more durable pump.

Unfortunately, the available semi-automatic pumps single pumps (sold at most chain stores) are ineffective and even painful for many mothers. These include pumps made by formula manufacturers, such as the Gerber pump (the most widely sold breast pump in the US), or bottle manufacturers, such as the Evenflo pump. Mothers with very responsive milk let-downs may find these pumps effective, but many mothers do not, because they generate suction so slowly that they provide at most only four to ten suction and releases per minute, the fewest of any pumps sold. In addition to providing little stimulation for milk expression, with normal use a mother's nipple may be drawn down into the nipple tunnel for up to 15 seconds before release, which is painful for many women. A lactation consultant at Northwestern Memorial's Prentice Women's Hospital estimates that these pumps work well for about 50% of the women who buy them.

MANUAL PUMPS

For some mothers, a manual pump may be a good choice. There are several styles of manual pumps, which require the mother to generate the suction and release by pulling on a cylinder or a piston or by squeezing a handle. My favorite manual pump is the Ameda One-Hand Breast Pump, which requires the least amount of effort. Suction is generated by squeezing a handle, and as its name suggests, it can be operated with one hand, allowing the mother to pump one breast while her baby nurses on the other. It also comes with a silicone flexishield, which fits into the breast shield and offers a soft, massaging action while mother pumps. It is currently priced at $33.50.

Another variation on the manual pump is Medela's PedalPump, which uses a foot pedal to power a single or double pumping kit. To use it, you need both a pedal ($53.85) and a Medela Lactina Double Pumping Kit ($44.65).

Most mothers find that they need some practice to get good at stimulating a milk let-down with a manual pump. If the milk does not let down (which causes the muscles around the milk-producing glands to squeeze the milk from all parts of the breast toward the nipple where it can be accessed), a mother will get little milk for her efforts. With a manual pump, a mother must learn to generate a rhythm of suction and release that will trigger her let-down.

BE DISCRIMINATING

In many cases, the choice of a breast pump can make the difference between a mother meeting her breastfeeding goals and having to settle for a disappointing experience. When selecting a breast pump, it is important to consider how it will be used, taking care to choose the right equipment for the right job. Just as it wouldn't be sensible to try to remodel a home armed with only a screwdriver, neither is it a good plan to try to return to work full-time with a semi-automatic single pump or a manual pump.

Investing in the right breast pump pays back many times over. The cost of formula currently runs between $100 and $175 per month (depending on whether you use powdered, concentrate, or ready-to-feed). This doesn't include the expense of the extra sick visits, medications, and hospitalizations that are more common among artificially fed babies. Choosing a breast pump wisely can help a mother meet her breastfeeding goals, providing cost savings for herself and better health for her baby.