Thursday, March 26, 2015

Nurse Charity shares her wisdom about breast pumps




What Breast Pump Should I get?

This is a common question here at the office, it used to be that only moms with sick babies, or moms going back to work even thought about a breast pump, but now they are so part of our breastfeeding culture, even Moms who are only looking to offer an occasional convenience bottle of expressed milk are asking about what pump to buy.  Here is a short little run down.

Pro tip:  If you have a non-latching baby, a preemie baby, or a baby who is not gaining appropriate weight you must hand express well, or have a hospital grade pump.  I know the sellers and manufacturers say their home pump product is as good as the hospital grade pumps.  They are not.  Rent a pump!   

There are a lot of pumps out there- I mean a lot, a lot, A LOT!  Everyone is trying to get in on the breast pump market, and new ones pop up all the time. This is a post about the tried and true.  No pump out there is perfect, current technology focuses on suction as a way to move milk- and misses the all important complementary action of compressions!  Here are the pumps I recommend- they all have flaws- I will list my qibbles along with the recommendation.  If it made the list- it is a good product, but there is always room for improvment.

Sometimes the best pump is NONE!

If you are pumping occasionally to offer a bottle every once in a while- really, any method of milk expression will work for you.  Hand expression, once learned is one of the very best ways to move milk quickly.  It is cheap, and really the only cost is the time it takes to learn.  Babies are portable, and so are breasts, so don’t feel pressure to introduce a bottle unless you really want to.  
It is legal in California to nurse your baby *anywhere* you have the right to be.

Pro tip: All moms should know how to hand express.  If the power goes out (like for an earthquake or other disaster) knowing how to hand express is crucial.  learn here:  http://newborns.stanford.edu/Breastfeeding/HandExpression.html
PRACTICE!



Pumps for the Working Mom

Double electric (meaning it pumps both sides at once, using electricity to drive the motor) purchased home use pumps are designed for moms with an established milk supply (have been nursing with good results longer than 6 weeks)  that are going to be away from their babies for 6-10 hours.  The two products easily available in the Bay Area are the Pump In Style and the Free Style from Medela, and the Purely Yours from Ameda.  

Medela-  The Pump In Style Advanced (PISA) gives moms a great double sided pump with automatic cycling (mimics the initial fast suck of a baby, then slows after a few minutes with greater suction)- almost as good as the hospital grade product.  Yay!  Drawback?  Most expensive, probably overpriced, is built into the bag it comes with, so you are stuck with whatever Medela thinks is trendy that year, usually basic black.  To try to address this issue they made another smaller, more portable pump they claim is as good as the PISA- The Freestyle.  If only the claims were true!   Most moms in our practice get significantly less milk with the Freestyle.  if you want a medela product, go with the PISA.   I am consistently disappointed in Medela.  The Pump in Style Advanced and Freestyle  continue to be open system pumps (meaning the milk can back up into the pump), and because of the risk of infection is not recognized for shared use.  Medela’s hospital grade pumps- The Symphony and the Lactina are both closed system (milk cannot get into the pump)- so they have the technology to make a better pump- and instead make each mom worry about cross contamination, and mandate (under void of warranty threats) that each mom buy their own.  In addition, they have yet to make all the tubing (the part that gets plugged into the pump) the same so if you have a kit for the hospital grade pump, it does not fit your home pump.  Boo Medela!  way to milk Moms for every penny.  A guy on youtube has a tutorial on how he takes pumps apart and cleans them.  Worth a look if you are borrowing an open system pump.  




Ameda-  The Ameda product is called Purely Yours,  it is a great home pump, with a closed system, the pump parts are interchangeable with the hospital grade offering (Elite or Platinum), a lot of insurance companies are covering this choice, and you can house it in your own bag.    Yay!  But it lacks the automatic cycling.  You can of course set the speed to fast, and the suction to light at the beginning and change it over with the let down to slower, with more suction, but most tired moms would prefer a single button like the Medela product.   In addition, about every 100 pumps, I get one with a bad motor (suction is poor, and the motor is LOUD!).  It needs to be returned as a dud, what new mom has the time for that?  


Hygeia- There is a less well known company, Hygeia, that also has home pumps and hospital grade pumps.  They are awesome!  (and the only pump company in compliance  with WHO marketing standards).  Great product if you can get it.  hard to find in regular shops, easy to order online.  Better motor than the Purely Yours, but no automatic cycle on the suction.   



There are some new pumps out there that don’t have enough of a track record yet for me to have an opinion either way (Like the Freemie pump) and a lot of pumps that are better to just avoid (anything made by a toy company, like First Years or the new Lansinoh pump, the old one was a purple version of the Purely Yours, the new one is not as good).


Pro-tip:  If you pump in the hospital- take the kit with you when you leave.  If you buy the home version of the pump you used in the hospital- then you will have two sets of flanges and extra parts.

Hand Pumps
There are other pumps out there, hand pumps and single electric pumps, of the two I prefer the hand pump- no electricity needed, and the designs are pretty mom friendly/easy to work.    The Ameda hand pump, and the Avent hand pump are the best manual single pumps. 





Single Electric Pump- Just skip it.

The single electric pumps from any brand are really just toys, if you want to have just an occasional bottle of expressed milk for a special occasion-  I recommend a hand pump, or learning to hand express.  Hand expression had be just as effective as an electric pump, once you know how to do it.  If you like the electric pumps- just buy the Purely Yours, or the PISA.   





            How to Pump

Ok I have the pump, I know how to hand express- now what do I do?

Wait until nursing is going *well* for 4-6 weeks.  We don’t recommend pumping for non medical need until after the first 4-6 weeks.  This lets you get the hang of nursing without adding any extra work.   Mostly the problem I see for Moms who start pumping early is oversupply.  Trust me, too much milk can be as much of a burden as not enough- so unless you need to, best to wait until the 1 month to six week mark.  

If you pump or hand express at the beginning of the day, you can collect the most milk.  if you are expressing to have milk for a sitter, or some stash for when you go back to work- the time that usually gives you the best yield is at the beginning of the day.  In general, because moms are trying to get some well earned rest, babies nurse a little less at night and as a result there is a little more milk in milk storage.  Although the definition of morning varies by family- I am not suggesting pumping at 4 or 5 am, but when you are actually awake, and ready to greet the day- sometime between 7 and 11.   

Pump directly after your baby feeds.  Baby nurses until milk drunk- then express/pump, both sides until the breast is very soft.  The time it takes for this varies- could be 10 minutes, could be 40 minutes- depends on how big your milk supply is, and how much milk is in milk storage.

Practice! Letting down to your baby is easy, letting down to a pump takes some practice.  Lots of moms pump the first time and get dribs and drabs- this does not mean you do not have milk!  It just means your body has not realized that the suction of the pump is an appropriate stimulus to remove milk. My Mom had a friend in the 70’s who pumped for her preemie baby- the pumps back then were LOUD.  When she got home, she found out that her body let milk down when her refrigerator  “cycled” making a loud humm.  Her body had learned to let down for the SOUND of the pump- not the suction.  Expect to pump-3-6x before the milk starts to really flow.


Tips for Comfortable Pumping

Lubricate the inside of the flanges.  Food grade oil, olive or coconut works well.  It prevents your damp skin from getting friction damage rubbing over the plastic.  

Set your suction at the highest part of comfortable, not the lowest part of tolerable.  Most women pick a setting of pumping that is a little bit uncomfortable, thinking the stronger suction will bring more milk.  Unfortunately, what facilitates letdown is oxytocin.  Pain, even the pinchy, tuggy pain of the pump can interfere with oxytocin circulation, and suppresses let down.  Make sure your pump is in the comfortable range.  To do that, I usually turn it up until it is barely pinchy- then back down to the comfortable range.   Once you know your comfort range- keep it there.    Even at the lowest settings, the pump will still be effective (that is why you got the good one- and skipped the crap).  

Do breast compressions while pumping.  Lactation consultants have recommended this for years- at least 20.  Now we have the studies to back up the recommendation.  Jane Morton calls it hands on pumping (ooh fancy name)  but really, all we are asking you to do is do a deep breast squeeze (deep- meaning you can feel the structure of the breast under your fingers when you compress) while you pump.  Studies show you can move up to 30% MORE milk if you do compressions while pumping.

If you use a hands free bra- make sure it FITS! A hands free pumping bra that pushes the flanges too deeply into the breast tissue can impede the flow of milk, and reduce your yield.  The flanges should seal, but not dig too deeply in any one spot.  

Several quick pumps are more effective long term than a few long pumps.  The breast is not a container- it is a modified sweat gland- so pumping more frequently helps keep baseline prolactin levels high, and moves more milk over time.  I know it is tempting to put off pumping, and pump a looong time (20-30 minutes), and see the full bottles, but trust me on this one.  If you have limited time- several short pumps (10-15) are better than 1-2 marathon pumps.

The longer you are away from your baby- the more pumping session you need to get in.  In general- if you are going to be away from your baby for 6 hours, you need three pumps, for 8 hours you need at least four pumps, for 10 hours, 5 pumps.  A pump does not move milk as well as a baby- so an extra pump helps keep it even.  

Milk storage guidelines are 5/5/5  5 Hours at room temperature, 5 days in the refrigerator, 5 months in the freezer.  You will see other recommendations- I like 5/5/5 because it is easy to remember.   

Happy Milk Expression!

Hint Mama adds the following tip: It's also worth noting that Obamacare heralded in free pumps for moms, so people no longer have to buy pumps. Here are the details:





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