Is there a particular type of pump to use?
There are several types of breast pumps available on the market.
How and why a mother intends to use the pump can assist you in
recommending a pump that suits her needs. All pumps consist of
basic parts: A breast flange, a collection area, and something
that produces a vacuum. Pumps that use a squeeze bulb for suction,
regardless of the size of the bulb, are not recommended. The suction
produced by the pump should be intermittent, not constant. It
is the rhythm of the suction, and compression of the areola inside
the flange that empties the milk in combination with the suction.
Suction alone, will not empty the milk.
Will insurance companies cover the cost of the pump rental?
It has been my experience that few insurance companies will reimburse
the parents for the cost of the rental for a sick baby. Companies
may view the rental of a hospital grade, electric pump as a luxury,
when there are small hand pumps available at a lesser cost. If
the pediatrician writes a prescription for the hospitalized baby
for "breastmilk," the prescription and the pump rental bill sent
to the insurance carrier.
How are the pumps used?
The "draw and hold" pump is used by applying suction for a few
seconds then releasing the suction for a second or two, and then
applying suction again. This should be done in a rhythmic fashion.
The mother should avoid applying too much suction or holding the
suction for too long. If the pump causes pain and/or leaves marks
on the breast, she is using too much pressure.
The "one pump per second" pump, (Medela ® Manual) limits the amount
of suction against the nipple and areola. The pump can be set
for light, medium or firm pressure. Simply pull the piston back
to the stop, push in, then pull out again; in a rhythmic fashion.
Medela ® has a spring for their manual breast pump that will automatically
push the piston out making the pump easier to use.
Large electric pumps are much easier to use. Simply connect the
equipment to the pump, plug the pump in and turn it on, adjusting
the suction for comfort.
How do I keep the equipment clean?
Always use clean equipment for pumping. Instructions for cleaning
come with most pumps. Only the parts that contact the breast or
milk need to be cleaned after each use. Mother should rinse the
parts immediately after each use in cold water to remove any residual
milk. The parts should then be washed in hot soapy water and rinsed
well. Between uses store the pump kit in a clean area or clean
plastic zip type bag. Daily sterilization of the breast pump parts
[not the tubing] is recommended only when the milk is collected
for a hospitalized infant. Sterilization can be done by boiling
the parts in a large pot at full boil for five minutes. If mother
notices hard water spots on the equipment, adding a little white
vinegar to the water each time she sterilizes the parts should
help. If the tubing has a filter (Medela ® ), be sure that the
filter does not get wet, as this will block the suction.
Will I pump as much as the baby takes?
The pump is not as efficient as the baby. It also will take a
while for the mother's let- down reflex to become trained to the
pump. If no let-down reflex occurs, the mother can expect to obtain
one-half to one ounce or less of milk from each breast. The mother
who is pumping immediately after delivery for a sick baby, may,
at best, express only a drop or two of colostrum. The goal of
early pumping is to establish a milk supply by repeated stimulation
of the breasts.
When a mother is learning to use the breast pump before returning
to work, I recommend that she begin at the first morning feeding.
Nurse the baby from one breast and then pump the other. The baby
will help get the breast "primed." If the pump doesn't seem to
work the first time she uses it, mother should be encouraged to
practice pumping frequently. If the pump still doesn't seem to
work after a week of practice, the mother should try a different
type of pump.
How can I encourage let-down?
There are many things the mother can do to encourage the let-down
reflex. Below are some suggestions. Not all the techniques work
for each mother.
1. Relax. Try Lamaze breathing techniques.
2. Warm packs or wash clothes applied to the breast for a few
minutes before pumping. Or take a hot shower.
3. Massage the breasts gently, with the heel of your hand, starting
at the chest wall and moving toward the areola.
4. Bend over and let the breasts hang free for a moment or two.
5. Develop a pumping routine. Always follow the same steps each
time you pump.
6. Turn the pump on for a minute before placing the flange against
7. Stroke your breasts in a feather light manner from the upper
edge near the arm pit, toward the nipple and areola while you
8. Look at pictures of your baby.
9. Listen to a recording of your baby's cries.
10. Smells are very powerful. Try smelling a piece of unwashed
clothing that the baby has recently worn.
11. Don't worry about how much you obtain.
How is manual expression of breastmilk done?
Manual expression of breastmilk is easy once a mother can get
the technique down. The technique for manual expression is discussed
below. Mother will need a clean, wide mouthed jar, bowl or a manual
expression funnel, because it is difficult to aim the streams
of milk into a small opening. With practice, some mothers feel
that manual expression is easier and less time consuming than
a breast pump.
1. Position the thumb and first two fingers at the edge of the
2. Push in toward the chest wall, spreading the fingers apart
3. Let the thumb and fingers roll toward the nipple using light
compression (don't squeeze).
4. Rhythmically repeat compressions.
5. Rotate the thumb and fingers around the breast to ensure emptying
of the ducts. Remember to avoid squeezing, pulling or sliding
on the breast or nipple.
TABLE : MANUAL EXPRESSION OF BREASTMILK
Copyright Marie Davis, RN, IBCLC 1999
February 11, 2012