Women’s Health Today

Robyn Roche-Paull, BSN, RNC-MNN, IBCLC

Which breast pump? Robyn aims to clear up some of the confusion that exists to help you choose the best pump for your particular situation.

There are so many different breast pumps available on the market today. Making a choice can be mind-boggling, not to mention time-consuming, as you try to figure out which pump is best for your situation. There are many factors to consider, such as how and where you will use it, what options you will have available for expressing your milk at your workplace, and whether it is within your budget. With so many pumps available, each with numerous features, including a range of cycle and suction settings, sizes, power sources, and prices, how do you begin to choose?

Breast pumps: the lowdown 

Many pumps claim to be the “next best thing to having your baby at the breast,” and it can be hard to cut through the hype to determine which is the best pump for your particular needs. There are four main categories of breast pumps—from hand-operated to hospital-grade. Here is a rundown of what they offer, the workplace situation they are best suited for, and their advantages and disadvantages.

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. You create suction 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 are very portable, as they are lightweight, small, and quiet. 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 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 work in an area with no access to electricity. Very few women can maintain a full milk supply using a hand pump full-time due to the pump’s inability to cycle at the same 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 there is an electricity shutdown.

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 drain the breast effectively 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. These pumps are meant for occasional use only, no more than a few times a week, and are best suited for those women who want to pump for a date night out or who work part-time.

Personal-use, electric, double pump. For employed 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. Personal-use pumps are excellent at maintaining a milk supply. 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 rechargeable battery pack. These pumps are best suited for use by working mothers with a regular pumping schedule and some place to pump.

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 or single pump, and are the most effective at mimicking a baby’s sucking pattern. Hospital-grade pumps are excellent at initiating and maintaining a milk supply. 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, meaning you must supply your own collection kit (which must match the pump brand and is not interchangeable). These pumps are best suited for pumping within a workplace lactation center.

Which features to consider

All breast pumps need to do one thing: remove the milk from your breasts. How that is accomplished and what makes one pump better than the next depends on its features. The problem is every manufacturer claims to have the breast pump that has the best features and most closely mimics a baby at the breast (and the U.S. Food and Drug Administration (the FDA) does not regulate these claims). Here are some of the features YOU need to look at when buying a breast pump. Keep in mind what makes a breast pump effective for one mother may not work for you.     

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 220 mmHg 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 them 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 10–15 minutes. Single pumping shouldn’t take longer than about 20–30 minutes.

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. There is no way to completely clean and disinfect this type of pump. The FDA recommends that open-system pumps be used by a single user because infectious particles remaining in the pump may potentially cause disease. 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.

If your pump is not listed here, check with the manufacturer or an International Board Certified Lactation Consultant (IBCLC) to determine if it is an open or closed system

• 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)

Adapters and batteries. What kind of power will you have available? Some pumps require access to electricity, while others come with 12v car adapters. Some can run on rechargeable internal batteries; others require replacement AA batteries. If you are traveling overseas, make sure that you have the proper adapters 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 sections you don’t need at work. Some pumps are very large, bulky, and heavy, while others are small enough to fit in the pocket of a backpack or purse. 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 nightlights.

Spare parts. How easy is it to obtain spare parts for your pump, especially if you are overseas? Does the manufacturer ship overseas? 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 while traveling for business or pleasure.

Don’t choose a used breast pump

Some 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). 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 on to 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, while in other pumps the milk can go back up the tubing and get sucked into the motor, where mold can grow and then be blown back towards the bottles.

Many personal-use pumps are only made to last about a year with full-time use (about 2–3 pumping sessions per day during a work week) and most warranties are often only for a year. Buying a used pump runs the risk that the motor may be wearing out and no longer functioning at peak performance, 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 then it probably is because the motor is dying. Warranties are also voided when pumps are shared or used by more than one user. With the passage of the Affordable Care Act, breast pumps in the United States are a covered item by insurance companies. There is little reason to buy a used breast pump.

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. Your breast pump is the link between you and your baby when you are separated. It allows you to produce your baby’s milk and remain a committed breastfeeding mother. This is an important decision to make. For a downloadable handout with this information check out Choosing A Pump on the Breastfeeding in Combat Boots website.

Robyn Roche-Paull, BSN, RNC-MNN, IBCLC, is the award-winning author of the book, Breastfeeding in Combat Boots: A Survival Guide to Successful Breastfeeding While Serving in the Military and the Executive Director of the non-profit, Breastfeeding in Combat Boots.