BREAST PUMPS

Encouraging patients to use a breast pump

By Barbara L. Philipp, MD, IBCLC, and Anne Merewood, IBCLC

To promote breastfeeding after a mother returns to work, clinicians need to make knowledgeable recommendations about which breast pump to use and provide guidelines to ensure proper milk storage.

The American Academy of Pediatrics, citing breast milk as the "optimal form of nutrition for infants," recommends exclusive breastfeeding for approximately the first 6 months of life.¹ Similarly, ACOG's bulletin on breastfeeding states that "human milk provides developmental, nutritional, and immunologic benefits to the infant that cannot be duplicated by formula feeding."² Complementary foods should be added at about 6 months of age and breastfeeding should continue for at least the first year.¹ In line with these recommendations, the national goals of Healthy People 2010 are that 75% of mothers will initiate breastfeeding, 50% will still be breastfeeding 6 months later, and 25% will be breastfeeding at 1 year.³ Regrettably, breastfeeding rates in the United States don't come close to these goals. As of 1998, only 64% of new mothers in the US initiated breastfeeding and only 29% were breastfeeding at 6 months.⁴ In light of such statistics, Former Surgeon General David Satcher, MD, called the need to increase breastfeeding rates "a public health challenge."⁵

In the US, 60% of employed mothers rejoin the workforce before their infant is 2 months old. Studies suggest that returning to work within 1 year of the baby's birth is associated with a shorter duration of breastfeeding.⁶ Going back to work, however, need not be a reason for stopping breastfeeding. Breast pumps offer the means by which a mother can express her milk so that it can be stored and fed to the baby later and so that she can maintain her milk supply.

While pediatricians are ideally positioned to encourage continued breastfeeding, ob/gyns can also play an important role in this area.⁷ Anticipatory guidance on a variety of topics is a keystone of the physician's role, and breastfeeding is no different. Advice to help ensure "back-to-work" breastfeeding success is listed in Table 1.

TABLE 1
Back-to-work anticipatory breastfeeding guidance

Obtain a high-quality breast pump

Begin pumping at least once a day to build up a supply of frozen milk for later use

Introduce a bottle of expressed milk once a day

Make plans for a manageable back-to-work transition, such as working only two days the first week

Establish a space at work where pumping will be done

Confirm cooperation of the supervisor or manager in regard to taking pumping breaks

Plan refrigeration to be used at work and for transporting expressed milk home. Many "personal use" pumps come with a tote bag that has a cooler section for milk storage. A small cooler and a few blue ice refreezable ice packs work fine.

Find a photo of the baby or an item of clothing to take to work

Plan to breastfeed before leaving for work and as soon as returning home

Be aware that the first week back to work is the most difficult

Source: Meek J. Breastfeeding in the workplace. In Schanler RJ, ed. Pediatr Clin North Am. Breastfeeding, 2001; Part II: The Management of Breastfeeding. Philadelphia, Pa: WB Saunders; 2001.

When clinicians want in-depth information about breast pumps, they often seek out an experienced lactation consultant whose knowledge on the subject is up to date. With that in mind, I (Dr. Philipp) decided to pick the brain of an expert colleague, Anne Merewood, IBCLC, the lactation consultant and source of breast pump information at Boston Medical Center.

How does a breast pump work?

All breast pump manufacturers try to replicate the best "pump" around—the baby who sucks at a rate of 60 "suck and pause" cycles per minute. The infant's sucking capacity reaches a maximum negative pressure of about 220 mm Hg.^8-10 A breast pump works by reducing resistance to the outflow of milk from the alveoli by exerting negative pressure on the breast. The pressure generated within the breast by the milk-ejection reflex and pulsatile oxytocin levels pushes the milk out.⁹

Interestingly, much of what we know about the ideal design for a breast pump for humans comes from the dairy industry. Einar Egnell, a Swedish scientist who pioneered the human electric breast pump in the 1950s, based his early designs on cattle milking pumps.

Where do you start when a mother asks for help selecting a breast pump?