All breastpumps are NOT the same! When considering a breastpump, it's important to look for one that will come as close to mimicking what your baby does at the breast as possible. This is the difference in what makes a pump effective and comfortable versus one that is ineffective and may even cause discomfort or trauma to nipple or breast tissue. There are certain criteria to consider when comparing breastpumps. For purposes of this discussion, we will mainly focus on battery/electric pumps but will briefly discuss the manual pumps available on the market today as well.
Effectiveness. This for the most part translates to how well or how often the pump cycles, or creates suction and releases it. The healthy nursing baby will suckle 45-55 times a minute. Pumps which cycle closer to this range tend to be more effective at yielding the most milk as well as maintaining the milk supply more effectively. Look for pumps which cycle at least 25 times per minute. Those with cycling rates below 25 are often ineffective at yielding milk. In addition, their cycles tend to be longer (as well as less) and therefore may cause pain as the breast and nipple tissue is suctioned for too long a period. Pumps which automatically cyle also tend to be more effective than those which require the user to regulate the cycles, often by covering a hole, or pressing a button or bar. Cycles which must be user-controlled leave much to user-error.
The pump's suction strength is also important to know. Breastpump suction pressures range from 20-650 mm Hg negative pressure. Pressures above the high 200s often cause pain. Pressures below 150 are reported to be ineffective at extracting milk. A breastpump that is similar to a nursing baby creates 200-230 mm Hg negative pressure and cycles about once every second.
Comfort. Most of the time, pumps with the autocycling feature are more comfortable to use. Too many times, those that require the mother to break the suction result in the suction lasting too long. Some breastpumps also are limited to only one size breastshield. Mothers with larger nipples and/or breasts may find these "one size fits all" pumps uncomfortable. They may also find that the pump yields little milk for their efforts as not enough of the breast tissue behind the nipple is taken up into the shield; therefore the breast is not "milked" well. Alternately, some moms require a smaller breastshield due to smaller breasts or nipples. Look for pumps that come with a choice of breastshields or those that have a larger or smaller breastshield available as a separate purchase in case you should require a different size for optimal pumping comfort and success. Additionally, manual pumps that require a repetitive action may not be a good idea for those with hand or wrist problems, depending upon the type of hand action required.
Type of pumping action. - single, alternating, double. Single pumps, whether manual or battery/electric, only pump one breast at a time. This does not provide as good of stimulation as double pumping and the pumping time required is also longer (twice as long in some cases) This is still acceptable if you will only need to use a breastpump occasionally. Single pumps are most always a good choice for the stay-at-home mom or the mom only working part-time and needing to use a breastpump on average once a day.
Pumps that provide alternating double suction, where the suction is created on one side as it is released on the other, provide more stimulation and a faster pumping time than single pumps, but not as much stimulation or as fast a pumping time as a simultaneous double pump in which the suction occurs on both breasts at the same time. These alternating pumps, like the single pumps, are still good choices for moms who don't work outside the home or who only work part time.
Simultaneous double pumps, often referred to as hospital or professional grade pumps, offer premium pump performance. They pump both breasts at the same time, thus cutting pumping time in half over single pumping. Additionally, there is research to suggest that simultaneous double pumping increases the hormone responsible for milk production and therefore better maintains milk supply over a longer period of time.
Pump durability. When choosing a breastpump, it's important to have an idea of how often and how long you'll need to use the pump. Some pumps are designed to be used infrequently and therefore have smaller and less durable motors. Others are designed to be used frequently and for longer periods of time and therefore have larger and more durable motors. Don't make the mistake of choosing a pump that's purpose and lifespan fall below your pumping frequency needs. This will only result in premature motor wear and tear and perhaps a compromised milk supply once the motor begins to wear out. Manual pumps, of course, do not depend upon a motor for operation, and therefore do not pose the problem of motor wear and tear.
Other criteria that you may want to consider: One feature that you may be concerned about is the quietness of the pump. The larger the pump, the more likely that the motor will be quieter. The smaller the pump, the more likely that the motor will be louder and thus less discreet. Manual pumps, by their very nature, are very quiet. What power options the pump provides is also of importance. If you will need to pump in a place without an electrical outlet, then you'll want to consider a pump that comes ready to run on batteries or that works manually as well as on electricity or one which has a battery as an option for purchase or rental. How portable the pump is and how discreet its case may also be something to consider depending upon where you will be pumping and how often you will need to travel with the pump. How much time you will have to pump also may factor in. If you routinely have only a few minutes to pump, investing in or renting a simultaneous double pump will save you time. On the other hand, if your pumping schedule is more flexible, you may be able to get by with a single or alternating double pump. One important note: If pumping for a preemie or exclusively pumping, the best choice for stimulating and maintaining a healthy milk supply is a hospital-grade pump. Once breastfeeding is going well, you may be able to purchase a pump. Until that time, you need every bit of help in maintaining your supply since you don't have the benefit of your baby's help.
Pumps That Make the Grade
Single manual pumps: Avent Isis, Medela Spring Express, Medela Harmony, Medela Pedal pump (pumping action is done through pumping of the foot; allows for double pumping as well as single pumping), Ameda Egnell Hand pump, or Ameda-Egnell One-Hand pump. Note: All manual pumps require pumping action on the part of the mother. Make sure you read the instructions thoroughly on how to correctly use the one you choose so that the pumping action is effective, safe, and comfortable.
Single battery/electric pumps: Medela Mini Electric or Medela Single Deluxe. Note: These are the only pumps in this class that cycle often enough (30-38 cycles per minute) to provide enough stimulation and to be comfortable. They are also the the only pumps in this class which automatically cycle.
Occasional-use double pumps: Medela DoubleEase or Medela Double-Deluxe. Note: These are the only pumps in this class that cycle above 30 times per minutes and which provide for the automatic cycling. These two pumps also provide for alternating suction. One other in this class with a good track record is the Nurture 3 pump. This pump does require the mother to regulate the cycles.
Simultaneous double pumping professional grade pumps: Any of the Medela Pump In Style line of breastpumps or the Hollister Purely Yours.
Simultaneous double pumping hospital-grade pumps: Medela Classic, Medela Symphony, Medela Lactina, Ameda Egnell SMB or Ameda Egnell Lact-E.
Pumps That Don't Make the Grade
All of the following receive poor reviews in the lactation literature and have poor track records when used by the majority of breastfeeding mothers: Evenflo, Gerber, First Years, MagMag, Playskool. All of these pumps either allow for suction levels beyond what has been determined as safe for breast and nipple tissue or cycle far below effective frequencies (as low as 4-7 cycles for minute for some of them). Most also require the mother to regulate the cycles.
Cleaning Your Breastpump
The following is considered adequate for cleaning of breastpump parts if your baby is healthy: Sterilize all pump parts that will come in contact with breast or milk before the first use unless your parts came in a sterile package. Sterilizing can be done in a hot dishwasher (water temperature greater than 140 degrees) on the top rack or in boiling water for 10-20 minutes. After each use, wash these same parts in hot, soapy water and allow them to airdry or dry them with a clean paper towel if a faster drying time is necessary. Every third to fourth use - or at the end of a work day - sterilize these parts again. Electric and microwave sterilizers provide a faster, more convenient method of sterilizing breastpump parts; however, some pump manufacturers (including Medela) do not recommend this route of sterilization and will not guarantee their pump parts if sterilized in this way. Any part that does not come into contact with breast or milk does not need routine cleaning or sterilization. This would include any tubing that may be used with the pump. Tubing only needs to be cleaned if milk enters it. Then it should be boiled for 10-20 minutes. Following sterilization it is also recommended to "shoot" rubbing alcohol down through the tubing to hasten drying and prevent mold and mildew growth. Any parts of your breastpump which require routine cleaning and which can be separated should be for each cleaning. Note: If you or your baby are being treated for thrush, it's recommended that daily boiling of all breastpump parts that come in contact with breast or milk take place.
Is it safe to use a previously-used breastpump?
No pump manufacturer recommends this practice. Here is what two major companies, Medela and Avent, have to say on this subject:
"Many mothers have asked if they can safely sell, purchase, or use a previously owned breastpump. Medela is concerned about the health and welfare of breastfeeding mothers and their babies. Breastfeeding is certainly the best way to feed your baby, and is the gold standard of infant nutrition. There is some evidence, however, that certain serious viruses* may be transmittable through breastmilk. For this reason, it is not advisable to use a previously owned breastpump. Breastpumps are single-user products, or personal care items, much like a toothbrush, and are registered with the FDA as single user items. For safety, breastpumps should never be shared, resold, or lent among mothers. Medela strongly discourages mothers from re-using or re-selling previously owned breastpump equipment. The Medela Pump In Style? Breastpump has an internal diaphragm that cannot be removed, replaced, or fully sterilized. Therefore, the risk of cross-contamination associated with re-using a previously owned pump such as the Pump In Style cannot be totally dismissed. Multiple use of single-user breastpump automatically voids the warranty of the Medela product. Each mother who wishes to express milk with a pump should use a clean, uncontaminated breastpump. This is the safest way to eliminate any risk of cross-contamination. Rental pumps such as the Classic and Lactina? pumps are made to be safely used by repeated clients who each use their own clean personal rental kit, therefore avoiding any possible cross-contamination. Rental pumps, when used according to the Medela instructions, are safe to use by multiple mothers who have their own personal kits."
"We at Avent America are always striving to provide mothers with quality products at reasonable prices to help them breastfeed longer. Research has shown that breastmilk can transmit many contagious viruses. It is for this reason that we strongly recommend that you NEVER use a previously owned breast pump. The Isis Breast Pump is considered to be a personal care item and has been designed to be for single use only. Mothers should never share breast pumps. Sharing or using a previously owned breast pump could put you and your baby at a potential risk for exposure to serious health risks. Some of the viruses that can be within breast milk are: HIV - Human Immunodeficiency Virus (AIDS) HTLV-1 Human T-Cell Leukemia Virus Type I CMV - Cytomegalovirus When you are using a previously owned breast pump you create the risk of cross contamination. It is for this reason that AVENT AMERICA STRONGLY SUGGESTS NEVER USING, BORROWING, PURCHASING OR SELLING A PREVIOUSLY USED/PRE-OWNED BREAST PUMP. Since a mother's breast milk is the most precious gifts of nutrition/health she can give her baby, DON'T take the chance of sharing someone else's viruses with your baby. "
If you still find a reason to use a previously-used pump, do take some precaution and try to replace every part which might come in contact with breast or milk. While this will not prevent all possible risks, it will greatly decrease them.
What if pumping hurts?
There are several things to consider if pumping is uncomfortable for you:
Is your pump of good quality? Many moms complain that lesser-quality pumps hurt. Use the information given above to determine if you have a good quality pump. A good pump should NOT hurt!
Do you have the pump suction or speed turned up too high? You should only turn the suction and speed up as high as your comfort will allow. If the pump hurts, try turning the suction and/or speed down some.
Is your nipple centered in the breastshield or flange? A nipple that is not centered may rub or be pinched up against the sides of the breastshield tunnel.
Are you pumping too long? Most moms should limit pumping to no more than 20 minutes at a time. Pumping for very long periods is more likely to make your nipples tender. Shorter, more frequent pumping sessions do more to increase and maintain supply than longer, less-frequent ones anyway.
Are you using the insert piece in your breastshield (if it came with one)? These extra pieces are designed for moms with smaller nipples. If you have been using the insert piece, try taking it out and see if that makes pumping more comfortable for you.
Is the breastshield large enough for your nipples and/or breasts? Some pumps may only come with a standard breastshield. This is designed for the "average" mother. Some moms may require a larger breastshield in order to accomodate a larger nipple or allow for more of the breast tissue to be accepted into the breastshield. Many pump manaufacturers make larger breastshields which can be purchased separately. For example, Medela makes the PersonalFit breastshield which can be used in place of the standard breastshield. Medela also makes an even larger glass breastshield if required by a mother. Other breastpump manufacturers may have similar products. Check with your pump's maker.
Are you holding the suction too long? If using a breastpump for which you have to release the suction you may be holding the suction for too long. Try shortening the amount of time that you actually hold the suction; and thus make your suck/release cycles shorter, or consider using a pump that automatically releases the suction for you (see information above).
Could you have thrush? Discomfort with correct pumping is often a sign of thrush, especially if pumping has been pain-free before.
One Final Word
When considering the purchase or rental of a breastpump, try to think of it as an investment in your's and your baby's present and future physical well-being. A good quality breastpump is not a luxury but an essential item for any mother who must use a breastpump at all! Compare the price of an effective breastpump to the cost of infant formula for one year (about $1200 for the least expensive form). You wouldn't think of scrimping on a lesser-quality car seat for your baby. You shouldn't try to get by with a poorer-quality breastpump either. Your comfort and your success with pumping and providing your baby with your own milk is priceless! Pumping: an act of love!
Sources:La Leche League's, "The Breastfeeding Answer Book" by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC (1997).
"Helping Employed Mothers Optimize Milk Supply" by Linda Shrago, RN, MS, IBCLC as lectured at the La Leche League Lactation Specialist Workshop Series VIII, "Breastfeeding: Overcoming Challenges in Today's World", October 24, 1998.