I am have been thinking about buying a breast pump. What is the best kind of pump to buy?

There are many different kinds and styles of breast pumps to choose from, and the vast array available to the consumer can sometimes be confusing. The kind of breast pump you decide to buy will be based on several factors, starting with how often you are going to need to pump milk for your baby. Moms of preterm infants and moms that are going to be away from their baby for a significant portion of the day (such as returning to work full-time) have different pumping needs than moms who only want to pump a little extra milk for an occasional outing. If you are going to be pumping multiple times a day for a long-term situation (such as with a very ill baby or preterm infant), then you would probably profit most by using a semiautomatic electric pump that has controls for both suction power and how many cycles of sucking there will be per minute. While there are other brands, Ameda and Medela seem to be the most popular. You can either rent these pumps from a pump rental station (call the hospital where you delivered or a lactation consultant in private practice to find a pump rental station) or you can purchase one from an independent distributor. Pumps that are rented are usually intended for very long-term use by many people, so they have a different kind of motor and housing. They are usually more bulky to transport. Electric pumps for purchase are usually intended for a single user and are packaged for convenience and transport. They are usually not very heavy either. Monthly rental rates can vary anywhere from $20-$45 a month (with an extra one-time expense for the flanges and tubing--single pumping or double pumping kit--commonly anywhere from $15-$45). If you are trying to decide if the extra expense of a double pumping kit is worthwhile, consider how long you are going to be renting the pump and why. If pumping for a preterm infant, the stimulation provided by double pumping will cause higher levels of prolactin in your body (similar to nursing twins) and is probably helpful for the early establishment of milk supply when your baby cannot be at the breast. Double pumping is also convenient, cutting pumping time in half. If however, you are only renting the pump for a unavoidable day or two away from your baby, single pumping kits are adequate and usually $15-$20 cheaper. Purchase price for an electric pump with the capability to double pump can be anywhere from $150-$300 (depending on discounts offered by the distributor). There are many online vendors of breast pumps (including the site linked below), but you can also call a local La Leche League leader for information on breast pumps that you can purchase directly from La Leche League (for a listing of LLL leaders nearest you, visit La Leche League's web site).

If you only need to pump for occasional outings without your baby, you would probably be served just as well with a manual pump. Medela makes a manual pump that I have personally used and found very easy. Many moms with whom I have spoken like it because it fits into the Medela rental pump (thus providing a kit for them if they ever have need of a rental). I have talked to at least 3 dozen moms that have purchased the Avent Isis manual pump who found it to be worth the extra expense over the Medela manual because they liked the fact that they could use it one-handed. In a similar price range as the Avent manual is the Medela mini-electric. Many moms like the convenience of an electric pump but have no need of a more expensive model with a motor designed for multiple uses per day over a long-term period. The Medela mini-electric is also not set up for double pumping like the Lactina or the Pump-In-Style. I know of quite a few moms that were very satisfied with their purchase of the Medela mini-electric. One did report to me that the motor died after only a year of use, but Medela did replace it for her. My experience with Medela is that they stand behind their product. Unlike other manufacturers with smaller electric/battery operated pumps on the market, Medela is not primarily in the baby bottle market, and is working to develop products and resources solely for the breastfeeding mother. It is my opinion that their commitment solely to breastfeeding shows in the quality of their product.

My baby was born at 33 weeks and will be in the hospital for several weeks before she comes home. Is there anything special I should know about pumping for my baby?

Most hospitals have special guidelines for the pumping and storage of milk for preterm or sick babies that cannot nurse at the breast. Check with the nursing staff to find out what the guidelines of your particular hospital are. Some have rules about what kinds of containers the milk should be in (glass or hard plastic containers are best because plastic nurser bags can leak and/or cause damage to the nutrients in the breastmilk; also fats cling to thin plastic nurser bags, thus wasting precious calories and fat that the baby needs), and how they should be labeled. Your name and the date the milk was expressed needs to be clear and easy to read. You will also want to ask if the hospital prefers you to simply refrigerate your milk or freeze it. Several studies have been done to investigate preparation techniques for washing the hands and breasts to further insure that the preterm or sick baby is protected from any extra bacteria. You'll want to ask your hospital staff if there is any kind of special hand washing protocol you need to follow (for instance: to use Phisoderm instead of regular soap, or scrubbing under your nails). Because preterm or sick babies are more at risk from those types of things, moms in those circumstances usually have to take more precautions than moms of full-term, healthy infants. It is not advisable or necessary to go to such precautions with full-term, healthy infants as a natural, normal exposure to minimal bacteria left after normal hand-washing is actually part of the building up of the immune system. In addition, moms of healthy, term infants do not want to damage the delicate balance of the areolar tissue and its natural cleansing, moisturizing system with the use of soaps.

As to the amount of time you should pump, you should plan on pumping every three hours during the day, and at least once at night. I usually suggest to moms that they not allow intervals longer than 4 hours at night, so their pumping pattern more closely imitates that of a nursing baby. If you have several pumping sessions that need to be closer together in the late afternoon/evening, all the better, because that is also more like the natural pattern of a breastfed baby. The standard advice is to pump for several minutes after the last drops of milk you see dripping out (except when you are still producing colostrum). Most moms use a double pump for about 10 min., but that can vary greatly from mom to mom based on strength and consistentcy of let-down pattern. Some moms may need less time, some moms more. Once your milk comes in, you should expect to pump what a baby would eat at an average feeding (approx. 2-4 oz. in the early weeks). If you are pumping for premie twins, you may want to set up times for pumping that are very consistent. While it is not uncommon for moms to be able to provide enough breastmilk for twins, getting started can be challenging and tiring. I have helped several moms with pumping for twins. The general recommendation I have given is to pump for 15-20 minutes, three hourly, with only one 4 hour break at night. In the situations I have personally supported, the moms were able to provide enough breastmilk for their premie twins with extra to save in the freezer. Once the babies come home, there is an extra need for support from a lactation professional while feedings at the breast get established. Until feeding at the breast is well-established, pumping after feedings must usually continue to make sure that the breast is getting enough of the right kind of stimulation and that milk is being removed from the breast. Whether bringing home multiples or singletons who have been hospitalized with mom pumping, mom needs a tremendous amount of support to bring the baby to the breast for feedings. It is often best to arrange this type of support before bringing the baby/babies home.

How long is my breastmilk safe to use when stored in the refrigerator or the freezer, and how long is it safe to leave out if I accidentally forget to put it in the refrigerator/freezer?

First, let me say that there are many different studies that have examined the safety of breastmilk under various conditions. When giving public advice, I always give conservative information because different variables as defined in those studies may not be as well controlled in other situations. When you are in doubt of whether or not breastmlk is safe to use, use the "sniff it & taste it" test before you throw it out. Simply smell and taste the breastmilk if you are unsure. That way you are not wasting precious "liquid gold" by throwing it away!

The best containers to use for the storage of frozen breastmilk are either glass or hard plastic containers that can be tightly sealed. Plastic nurser bags can leak and/or cause damage to the nutrients in the breastmilk, and fats cling to thin plastic nurser bags, thus wasting precious calories and fat that the baby needs. If you want to use plastic bags, you should purchase the kind that are specifically designed for the storage of frozen breastmilk (Medela is one company makes these and they can be ordered at the site below or directly from La Leche League). Once you express and store your milk, you should clearly label it for storage with the date you expressed it. If you are only pumping small amounts of milk at a time, you can still obtain a full bottle in the freezer by simply freezing the first amount that you pump. Succeeding amounts of expressed breastmilk should first be cooled completely in the refrigerator and then added to the already frozen milk in the freezer. Body temperature milk added to the frozen milk would cause a layer of milk to thaw then refreeze, and could cause it to spoil and become unusable.

In a frost free refrigerator, store the milk away from the ice thawing unit, and towards the back of the freezer instead of near or in the door. If you are not using the milk within 48 hours, you should just freeze it. Once the milk is expressed, it may safely be stored:

• at room temperature for 4 hours
• in a cooler with ice or an ice pack for up to 24 hours
• in a refrigerator for up to 72 hours (3 days)
• in a freezer that is part of a refrigerator for up to 3 months
• in a deep freeze for up to 6 months

To thaw frozen breastmilk, leave it in the refrigerator overnight, or in a cup of lukewarm tap water. Do not use a microwave to heat or thaw breastmilk as it may destroy some of the immunological components of breastmilk or burn your baby. Instead, simply warm the bottle in a cup of warm water. Never refreeze previously frozen and thawed breastmilk, and use it within 24 hours of thawing.

In the early months, you may find that freezing your milk in smaller increments of 2-3 ounces at a time is adviseable to avoid wasting breastmilk. Some even find that using an ice cube tray that is stored inside double freezer storage bags works nicely because it is easy to thaw only the specific amount that is needed (just make sure you use hard plastic ones as opposed to flimsy ones). You will quickly learn how much breastmilk your baby needs when you are gone from him/her. In addition to that, you may find it easiest to pump a little bit at a time versus trying to pump a whole bottle's worth if you know you are going to be out. Many moms find that the easiest feeding of the day to pump is the first feeding of the day. Babies often have a longer sleeping span at night, and moms can often pump off an extra ounce or more then. That way, a mom doesn't have to try to pump in between feeds and work for her milk to let down. Pumping directly after the baby nurses means your baby gets the milk flowing for you. Some moms elect to pump every day after that morning feeding as a part of their routine so that they have extra milk set aside for occasional outings without the baby or for adding to baby cereal after the baby is six months old or older.

I am having trouble pumping when I am away from my baby. Sometimes I can only get a half ounce of milk after pumping for 30 minutes even though my breasts feel full.

Some women have a difficult time getting their milk to let down when they are away from their baby. If you are having trouble with this, here are a few tips that may help:

• hold a warm (not hot) washcloth or towel on your breast until it cools
• lightly massage your breast and try to hand express a few drops of milk
• bring one of your baby's sleepers or cloth diapers with you that would have baby's scent on it
• have a picture of your baby nearby while you pump
• create a mental image of sitting with and nursing your baby
• imagine a water fall of milk crashing down instead of water
• use a relaxation technique that is helpful for you such as taking a deep cleansing breath followed by deep slow breathing, or tensing up and relaxing different muscle groups
• play some soft music (or a sound spa that has relaxing sound on it) or burn a lightly scented aromatherapy candle (of course well away from the pump and pump parts!)
• Oxytocin used to be available in a nasal spray, and at least one study showed that moms benefitted from its use. If you are interested in that approach, you will want to talk to a knowledgeable breastfeeding professional and find a pharmacist willing to compound it for you.
• DO NOT simply increase the suction strength of the pump hoping more power will solve the problem. That could lead to soreness and nipple injury. Always start the pump on the lowest possible vacuum setting, and increase it only to a level which is comfortable.