I decided to write this blog after seeing a mum post on a Facebook breastfeeding group asking for pump recommendations. The Admin for that group directed her to a link on the American Kellymom.com breastfeeding website on buying new and used breast pumps which really is not particularly helpful. I did a quick google and really could not find anything useful to help a mum select an appropriate breast pump from the vast array on offer. This reaffirmed to me the difficulties mothers in this situation face. I see families daily who are using a breast pump that is not appropriate to meet their needs or who have spent hundreds of pounds on a pump that remains in its box unused.
Why do you need to express?
So, as a parent how do you choose a breast pump? There are many reasons why you may need to or want to express. The reason for expressing will also dictate how often you will be pumping. This is key to choosing a suitable breast pump.
In the early days after birth you may find you need to pump frequently to provide milk for your baby who, for whatever reason, is not able to latch and feed directly at the breast. Or your baby may be struggling to drain the breast effectively. Frequent expressing will be needed to stimulate milk production and manage engorgement as the milk starts to come in. Later, you may need to express because of inefficient feeding and/or slow weight gain to provide top ups and/or boost a low supply. As baby gets older you may want the flexibility of being able to leave her baby in the care of someone else so you can have a break, go to bed early or attend appointments. You may be returning to work and need to leave milk for your baby.
There may also be situations where a mother wishes to re-establish a milk supply after a break from breastfeeding (relactation). More parents are now inducing lactation in situations where they are adopting a baby, or in same sex couples where the non-birthing parent wishes to share in the breastfeeding, or where a parent is transgender. Both these situations usually necessitate frequent expressing.
Not all breast pumps are the same
Not all breast pumps are equal, and some are designed for frequent use, whereas others are more suited to occasional use.
When a baby cannot latch and suckle effectively at the breast immediately after birth due, for example to prematurity, illness in the baby or mother, other additional needs, an oral abnormality such as a cleft palate or tongue-tie or simply because of a difficult birth then it is vital that expressing starts early. This will ensure a good milk supply is established and provide colostrum for the baby. Early stimulation and drainage of the breast helps to further develop the glandular tissue (the milk factory) within the breast.
Furthermore, once the milk comes in at day 3-6 milk production begins to switch from endocrine control (driven by hormones) to autocrine control (driven by the frequent and effective removal of milk from the breast).
Hospital grade pumps
So which type of pump is most suited to this situation? Expression of colostrum in the first few days is best done by hand expression due to the small amounts of colostrum produced. However, once the milk starts to come in then a double electric breast pump is recommended. Preferably a hospital grade pump as these are designed to be used by multiple mothers, multiple times per day. They are powerful, robust, and durable and offer smoother cycling curves than personal use double pumps. Double pumping not only reduces the time required to express, as both breasts can be expressed simultaneously, it also tends to stimulate more milk production (Jones et al, 2001) .
Hospital grade pumps are expensive so are usually hired, rather than purchased. In the UK there are three companies who provide pump hire services:
Some Children’s Centres loan out breast pumps for free. This happens in my local area. However, the pumps which are loaned out in my area are ‘personal use’ double pumps, not hospital grade. They are also loaned out with just one collection set meaning they can only be used to pump one breast at a time. Parents are sometimes placed on a waiting list. So, they are not suitable in the situations previously described. It is important to check that what you are being offered is right for the purpose you intend to use it.
Personal use double electric pumps
Personal use electric pumps come in double and single options. All double personal use pumps can be used as a single pump. However, most single electric pumps cannot be converted to double. Double personal use pumps are good for maintaining supply, returning to work or for boosting supply if for any reason it has dipped. Many mums will switch to a personal use pump, after the first month or so, when they have established a good supply with a hospital grade pump, if they are in a situation where ongoing frequent expressing is needed.
Sometimes, mothers experience a drop in supply after the early weeks due to illness, the use of formula, certain medications, an undiagnosed latching or sucking issue (commonly a tongue-tie), or because they have implemented scheduled feeding to get baby into a routine. Double personal use pumps can be extremely helpful in boosting supply in these situations. Generally supply recovers more quickly and efficiently than with a single electric pump. Double personal use pumps are also helpful when returning to work as pumping sessions at work will take less time.
Single electric pumps
Single electric pumps can be used for the same purposes as the double personal use pumps, but pumping will be less effective and more time consuming. They are more suited to mothers who only need to pump once or twice a day to stock the freezer or provide milk so someone else can feed the baby. Some single electric pumps, such as the Medela Swing Flex, retail for the same price as personal use double pumps, such as the Ardo Calypso, so this is something to be aware of.
Electric pumps, whether single or double, can be helpful in effectively draining breasts affected by engorgement, blocked ducts, or mastitis when a baby is struggling to do this, or the nipples are too sore for breastfeeding.
Hands free pumping
What about hands free pumps like the Elvie? These are relatively new to the market. They can be useful for mothers who need to pump on the go or discreetly and my feeling is that working mothers with established milk supplies are the ones who may benefit most from this type of pump. I have had a few mothers use the Elvie in the early days of their breastfeeding journey, but supply has been slow to pick up. This is probably because we know that double pumping is most effective at this stage. Plus, the design of hands-free pumps necessitates the use of a very small motor which is not likely to be as powerful as the much larger motors found in the hospital grade pumps. For a single pump hands free designs are comparatively expensive.
There are other ways to achieve hands free pumping. The simplest way is to use a ‘pumping bra’ or, if you have basic sewing skills, convert a standard nursing bra or close-fitting crop top for the purpose. Freemie cups are cups that can be worn inside your bra and in place of the flange and collection bottle on your usual pump. They are compatible with the major brands of pumps. Some pump companies, such as Spectra, make their own hands-free pumping kits.
Manual and silicone pumps
But what about manual pumps and the all-in-one silicone pumps? These are useful for the occasional pumping session for the occasional bottle feed or for softening up engorged breasts for making latching easier. Many mums get in to the habit of using the silicone pumps for collecting the milk that is ejected when the baby is feeding on the opposite breast, rather than allowing this milk to soak into a breast pad and be wasted. However, caution is needed when doing this. Unlike breast shells which are designed to simply collect ‘drip’ milk from the ‘let down’, the silicone pumps actually create suction at the breast and draw milk so frequent use can result in an oversupply. Over supply can be associated with engorgement, blocked ducts and mastitis for mum and latching difficulties, gulping and choking, wind and reflux for baby.
When choosing a breast pump correct flange fit is vital. An ill-fitting flange will affect pumping efficiency and can cause damage to your nipples and breast tissue. Not all makes and model of pump come with the option of different flange sizes. The cheaper pumps tend to come with just one flange size and if this does not fit there is no option to buy a different size. Some pump flanges have soft silicone inserts which can be removed to create a larger flange and some pumps are supplied with more than one flange size. But in most cases if the flange supplied with your pump does not fit then you will need to buy a different size. Manufacturers have fitting guides on their websites but as a rule you will need a flange that is about 4mm larger than the diameter of your nipple. One nipple may be much larger than the other, so some mums find they need a different size flange on each breast.
The availability and cost of spare parts is also something to investigate before you buy. With cheaper pumps it is unlikely you will be able to obtain spares in a situation that a part gets lost or damaged. The cost of spare parts for some brands of pump are higher than for others.
Some electric pumps work just off the mains. But others have the option to work off a battery, making them more portable, or can be powered via the 12-volt socket in a car which means you can pump in locations away from home and mains electricity.
The quality of a pump is something to consider too. Generally speaking pumps made by companies whose core business is the manufacture of breast pumps are better in terms of reliability, efficiency and durability and they often offer better after sales service. They dedicate a lot of resources to research and development of their products. Pumps made by bottle manufacturers, such as Tommee Tippee, in my experience do not compare well. Why would they? Bottle manufacturers make their money from families who formula feed and the breast pump in their range is purely a complement to their other products, not their core business or main source of income.
Second hand pumps
Finally, a word about second-hand pumps. These may seem like a good idea as they are cheaper than a new pump and many mums are given second-hand pumps by friends and relatives. However, in my experience there can be problems with this. Some second-hand pumps have been very well used and may be third or fourth hand. Even if they have only had one previous owner, she may have used the pump for more than one baby. I have seen many situations where a mum has complained that she cannot pump much milk or her supply is not increasing and upon investigation I have found that she has been using a second-hand pump with a worn out motor or defective parts.
Parts, particularly the crucial but delicate valves, can easily get damaged during use and plastic can deteriorate with repeated cleaning and sterilising, and storage meaning that seal and therefore suction is compromised. For these reasons and for reasons of hygiene it is recommended that collection sets are replaced and not handed on. Furthermore, not all pumps are ‘closed systems’, notably personal use pumps in the Medela range. This means that it is possible for milk to be drawn up the tubing and into the motor housing and this poses a theoretical risk of cross infection. So, if you do opt for a second-hand pump ensure that it has not been overused, replace the collection sets and check that it is a ‘closed system’ pump.
Sarah Oakley Independent Nurse, Health Visitor and International Board Certified Lactation Consultant 25/10/20