This section describes the different types of breast pumps available on the market today with recommendations for which ones are best suited for the AD military mother.
There are many factors to consider when choosing a breast pump, such as how and where you will use it, what options you will have available for expressing your milk at your workplace, and your budget. With so many pumps available on the market each with numerous features, including a range of cycle and suction settings, sizes, power sources, and prices, it can be confusing to choose the best one. In addition you can buy a pump from the drug store, the big box chain store, online or from your local Lactation Consultant. **At this time TRICARE does NOT cover breast pumps (however there is legislation pending that would make breast pumps a covered item under the ACA).** So what to do? I’ve tried to summarize the main points about features to look for and key points about each style of pump. (See the chart below for a concise listing of features, prices, and types of pumps). Be sure to read to the end of the page for must read information if you are considering a Used Pump.
Features to Consider
Cycles and Suction Settings. Breast pumps are designed to empty the breast by mimicking both the suction pressure and frequency of a baby’s suckling. A pump that cycles automatically between 40-60 times a minute will be the most effective at removing milk, keeping your prolactin levels high and your milk production up. Suction pressure affects your comfort, the efficiency of milk expression, and the production of milk. Suction levels that are less than 150 mmHg are ineffective at emptying the breast, and those that are more than 220mmHg can cause nipple pain. Most quality pumps will have either adjustable levels of suction and cycles (within the above specified ranges) that allow you to alter it to suit your needs, or pre-set controls that automatically create and release the suction. With many of the low-end pumps, you must regulate the suction and cycles manually by pressing a lever or placing and removing your fingers over a port.
Double vs Single Pumping. A good pump will allow you to pump both breasts simultaneously, which is faster and increases the amount of prolactin released, leading to higher milk production. Once you become proficient at pumping, using a double pump can take as little as 10 minutes. Single pumping shouldn’t take longer than about 15-20 minutes. Single pumping long-term can lead to lowered milk production.
Open vs Closed System. Breast pumps are based on either an Open or Closed system. In an Open system the pump motor is exposed to your milk as there is no barrier between the collection kit and motor. This can lead to the unintentional ‘drawing-in’ of your milk into the motor and the eventual growth of mold (the inside of a breast pump is warm, dark and damp…ideal conditions for mold growth), or the harboring of bacteria and viruses which can then be passed back into your milk at a later date (more of an issue for Used Pumps, see below). There is no way to completely clean and disinfect this type of pump. The FDA recommends that Open system pumps only be used by a single-user due to the ability of infectious particles remaining in the pump to potentially cause disease (while there have been no documented cases of this occurring, why take the chance?). In a Closed system the collection kit and pump motor are completely separated via a barrier (filters or membranes) so that your milk cannot reach the motor. This decreases the possibility of mold growth and infectious particles contamination. **For the active duty mother working with HAZMAT this can be concern due to the ability of HAZMAT particles to potentially pass through the tubing and into your milk. Closed system pumps reduce this likelihood.**
- Open – All Medela pumps except hospital-grade (Lactina, Symphony)
- Closed – Ameda (Elite, Platinum, Purely Yours), Bailey (Nurture III), Freemie (Freedom, Equality), Hygiea (EnDeare, EnJoye), Lansinoh (Signature Pro, Affinity Pro), Lucina (Melodi One) , PJ’s (Comfort, Bliss), Spectra (M1, S1, S2, Dew)
*If your pump is not listed here, check with the manufacturer or an IBCLC to determine if it is an Open or Closed system*
Adapters and Batteries. What kind of power will you have available? Some pumps require access to electricity, while others come with car adapters. Some can run on battery power, while others are hand-operated only. If you are stationed overseas, make sure that you have the proper adapter for the outlet or you risk blowing the motor.
Carrying Case. Is the pump portable and easy to transport? Does it come with a carry bag and have a compartment to keep your milk cool (especially important if you won’t have access to a refrigerator)? Many of the better pumps come with gel/ice packs that fit the compartment, and some have removable cooling compartments that allow you to leave unneeded sections at work. Some pumps are very large, bulky, and heavy, while others are small enough to fit in the pocket of your uniform (especially cammies or utilities). A professional looking “briefcase” or backpack will look better while you are in uniform. Many of the personal-use pumps come in a black, microfiber case with a shoulder strap.
Other Features. There are a number of other features available on breast pumps that you may want to consider. One of the most important is whether the flanges or shields are interchangeable. You want flanges that fit you correctly, as this can impact your milk supply. Some pumps have a “let-down” feature that automatically sets the cycles fast and suction light to mimic the quick sucking your baby does to help the milk flow. Other pumps offer a “cry” feature that allows you to record your baby crying (laughing or cooing), as that has been shown to help the milk-ejection reflex in breastfeeding mothers. Many newer pumps offer LCD displays that show the speed and suction, as well as time and length of your last pumping session. Other extras may include soft “petal” inserts that massage the breast, timers, and other similar items.
Spare Parts. How easy is it to obtain spare parts for your pump, especially if you are overseas? Does the manufacturer ship to APO/FPO addresses? Do they have a worldwide presence with parts that are carried by local drugstores and/or lactation consultants? This can save you a lot of heartache if pieces go missing or become damaged.
Breast Pumps: The Good, The Bad and The Ugly
With countless pumps on the market, each claiming to be the “next best thing to having your baby at the breast,” it can be hard to cut through the hype and determine what the best pump is for your situation. Here is a rundown of the four main categories of breast pumps–from hand-operated to hospital-grade–with what they offer, their advantages and disadvantages, and the workplace situation they are best suited for (a chart is included).
Hand-Operated Pumps. These pumps come in two basic types: cylinder and handle squeeze. Cylinder pumps have two cylinders: one inside the other, with a rubber gasket between them, and suction is created by pushing and pulling the cylinder in and out. Handle squeeze pumps create and release suction when the handle is squeezed and released. Both types of pumps are very portable, as they are lightweight, small, and quiet. Most hand pumps can be broken down into pieces and stashed in your uniform. These usually do not come with a cooler or storage case (the Ameda One-Hand and the Avent Isis are the exceptions), and they are easy to clean. Some active-duty mothers buy two hand-operated pumps in order to pump both breasts simultaneously. Hand pumps are best suited for women who need to pump to relieve fullness or while in the field with no access to electricity. Very few women can maintain a full milk supply using a hand pump full-time due to the inability to cycle it at the speed a baby sucks. It can be useful to keep a spare hand-pump with you in case you are without your regular pump or the electricity goes out. Examples of the better hand pumps on the market include the Avent Isis®, Ameda One-Hand®, and the Medela Harmony®.
Occasional-Use, Single or Double pumps. Occasional-use pumps, whether single or double, are generally “semi-automatic,” meaning they require that you manually cycle the pump. Even if the pump is labeled as a double pump, most cycle too slowly to effectively drain the breast or provide the proper stimulation to increase your prolactin levels enough to maintain a milk supply. These pumps can be battery operated or use an electrical adapter. However, the cost of batteries adds to the overall expense of the pump (and they go through batteries quickly). The pump may need to be replaced if used frequently over a long time period because the motor is small and not meant for heavy-duty use. Most of the newer models now come with a cooler or storage case. They are lightweight, small and often noisy pumps. These pumps are meant for occasional use only, no more than a few times a week and are best suited for those women who will not have access to electricity and need a portable, double breast pump. Some examples of the better pumps in this category include the Medela Freestyle®, Medela Swing®, Lansinoh®, Bailey Nurture III®, Whittlestone Expresser®, Avent iQ Duo/Uno®. Pumps to stay away from include the Playtex Embrace®, Evenflo Elan® or Comfort Select®, and the First Years MiPump®.
Personal-Use, Electric, Double Pump. For active-duty mothers who will be separated from their babies for 40 hours a week or more, these lightweight, portable, highly effective, and fully automatic pumps are the best choice. All of these pumps double-pump (and can convert to single pumping if need be) and cycle 40-60 times a minute automatically. These pumps have dual-control mechanisms, allowing you to regulate the speed and suction to suit your comfort. And some models have a two-phase pumping action, a fast ‘let-down” phase and a slower milk-expression phase. Most come in an attractive briefcase or backpack, with chill packs and a compartment for storing milk. They can be used with multiple power sources-electricity, AC adapters for use in a car/12v, and batteries or a battery pack. These pumps are best suited for use by those AD moms with a regular pumping schedule and someplace to pump and stash the breast pump when not in use. The most popular choices in this category include the Medela Pump In Style®, Ameda Purely Yours®, and the Hygeia EnJoye®.
Hospital-Grade, Rental, Double Pumps. These are the most efficient, effective, and comfortable pumps available. Hospital-grade rental pumps automatically cycle 40-60 times a minute with a very smooth action, can double-pump, and are the most effective at mimicking a baby’s sucking pattern. Like personal-use pumps, most hospital-grade pumps have dual controls for setting the speed and suction to your preference, and some also offer the two-phase pumping technology. These pumps are large and heavy, due to the industrial-size motor, and are not very portable, as most do not have a carrying case or a compartment to store expressed milk. They run on electricity, although a few offer battery packs for use when electricity is unavailable. Hospital-grade pumps are multi-user pumps, so you must supply your own collection kit ($50-65), which must match the pump brand and is not interchangeable. These pumps are best suited for pumping within a workplace lactation center. Hospital-grade pumps are very expensive to purchase (upwards of $1000 or more) and are normally rented on a weekly or monthly basis ($35-70/month). Examples include the Ameda Lact-E®, Ameda SMB®, Ameda Elite®, Medela Classic®, Medela Lactina® or Medela Symphony®, Hygeia EnDeare®, and the Limerick PJ’s Comfort®.
The type of pump you choose is as individual as you are, and what worked for your friend or co-worker may not be the best choice for you. Take your time and research all your options when choosing your breast pump. Need more information about choosing a breast pump? Check out these resources: LERON Online’s Recommending a Breast Pump, Diane Wiessinger’s About Pumps, and FDA’s Choosing a Breast Pump pages.
Used Breast Pumps: In a Word, NO
Many mothers consider sharing a pump or buying a used pump as a means to save money. This is not a good idea for a variety of reasons. Personal-use pumps are considered “single-user” equipment by the FDA and are not to be shared or resold. Breast pumps of this type cannot be properly sterilized between users due to the way they are built (open versus closed systems). And even with new tubing and flanges, airborne pathogens in milk particles may have entered the motor from the previous user, and then are blown towards the bottles where they can possibly be passed onto you, the next user. This can present a small, but nevertheless very real risk of transmitting certain bacteria and viruses from mother to mother (a mother can be a carrier and not know it or show symptoms). Also, in some pumps the milk goes towards a sealed chamber (like the Purely Yours©), while in other pumps the milk can go back up the tubing and get sucked into the motor (this happens with the Pump in Style©). Again, there is a risk that the milk could’ve been contaminated from the previous user’s milk, and mold can grow inside the motor and then be blown back towards the bottles.
Another consideration is that many personal-use pumps are only made to last about a year with full-time use (about 15-20 pumping sessions per week) and most warranties are often only for a year. Buying a used pump runs the risk that the motor may not function correctly or at peak performance, causing a loss of suction, which can negatively affect your milk supply. You can change all the membranes, tubings and valves you want, but if the suction seems to be decreasing…it probably is, because the motor is dying. Warranties are also voided when pumps are shared or used by more than one user.
So, is it ever okay to purchase a used pump? I am ethically bound to say no. But I know it will happen, so here are some guidelines to follow. There are plenty of pumps out there that have never been out of the box they came in, such as the pump your sister or a co-worker bought and used it for two days before quitting. That is a perfectly good used pump that may be suitable for you to use. However, a buying pump off E-Bay is NEVER a good idea. You simply do not know if it was used or not (regardless of what the posting says). But if you know the person, know her health history, know the history of the pump (how long it was used), and are positive that the pump was kept clean, you may choose to take the risk and use the pump. It is your decision. At a minimum be sure that you thoroughly clean and disinfect it, buy a new collection kit (membranes, flanges/shields, valves, and tubing), and have the suction checked by a lactation consultant before use. Understand that if the motor starts to die or lose suction you may very well lose your milk supply. So keep a close eye on your milk production. Here are some pages with further information on Used Pumps: LLLI’s Are Used Breast Pumps a Good Option? , and Breastfeeding Online’s Used Breast Pumps.
Legally, it is a no-no to share pumps. But reality says otherwise. Use your common sense and remember that I am not legally responsible if anything should go wrong because you followed the above advice!