Posts Tagged ‘breast pump’

The Most Frequently Asked Questions About Breastfeeding

Tuesday, August 31st, 2010

As an OB, my patients ask me just as  many questions about breastfeeding as they ask about pregnancy itself. I don’t mind at all because it is such an important topic. Over the years, I have scribbled many of these questions in my notebook so that I could research the most current information for new mothers eager to learn how to feed their babies the natural way.

Now, these questions are the basis for this week’s blog which is written just for you, with a completely different mindset and format than all my previous articles. Before writing however, I decided to interview the head lactation consultant, Ms. Renate Abstoss at Stamford Hospital in Connecticut, to get a second opinion and gather her responses. Ms. Abstoss sat for the first International Board Exam for Lactation Consultants in 1985 and has continuously worked in the field since that time in California, New York, Germany, Austria, Switzerland, and Connecticut. She was the first lactation consultant appointed as State Certified Teacher for Bavarian Midwifery schools.

There are probably many variations of responses to these questions so please consider this information helpful, but not absolute. I welcome any additional “pearls” from other lactation consultants or experienced moms so we can share the knowledge and promote the best nutritional health for babies everywhere.

  1. What are the most common problems that women encounter when pumping?
    Dwindling milk supplyis probably the foremost problem that women encounter when pumping milk. This can be attributed to many different factors.

    1. Infrequent pumping
      A working woman should try and pump every 3 hours for 10 to 15 minutes or at least for every missed feeding.
    2. Inefficient pumping
      Pump being used may have inadequate pressure or not enough cycles per minute causing a decrease in the milk supply.
    3. Lack of breast feeding
      Even when mom is home from work, she should try and breast feed the baby to stimulate milk production. For convenience, babies may be bottle fed too frequently.
    4. Painful nipples
      This can be due to a bad pump due to excessive suction pressure, pumping for too long a period of time, or poor latch when the baby does breast feed.
    5. Fatigue and exhaustion
      The stress of taking care of a newborn along with pressure from work and home can result in exhaustion and fatigue which can decrease the milk supply.
  2. How do I increase my milk supply?
    There are several medications and herbal products available to help with increasing the milk supply. To increase an existing milk supply, one can take two herbal supplements in combination fenugreek and blessed thistle, both of which are available in health food stores and have no known contraindications.The two most commonly used prescription drugs are Metoclopramide and Domperidone both of which were designed as stomach medications but were found to increase prolactin production in the brain. The medication Domperidone, (Motlium) is not approved for use in the United States and the FDA has issued warnings against the use of this drug as a galactagogue because in higher dosages, when given intravenously, Domperidone it was associated with cardiac arrhythmias and cardiac arrest. However, the small dosages that are used when given orally to increase lactation (30–40 mg/day) and for the short duration of three to six weeks does not seem to be a great concern. Patients generally obtain this medication from Canadian pharmacies or from Mexico and Europe where it is over the counter. Studies are now being conducted by ILCA (International Lactation Consultant Association) regarding the safety of domperidone.

    Metoclopramide (commonly known as Reglan), used to treat severe nausea in pregnancy, has been known to have a side effect of depression so its use has to be carefully monitored in the postpartum mother. The drug can be detected in breast milk and the long term side effects to infants is unknown.

  3. How do I treat plugged milk ducts?
    Milk ducts that do not drain can cause the milk to back up resulting in a plugged milk duct. Often the the surrounding breast tissue becomes hardened and inflamed. This area can eventually become infected resulting in a mastitis requiring antibiotic therapy. Plugged ducts often occur when:

    1. Mom misses feedings
    2. Mom fails to pump frequently
    3. The breast fails to empty
    1. Nursing more frequently
    2. Changing positioning
    3. Improving the latch of the baby (sometimes a shield is necessary). A lactation consultant would be very instructive in this situation.
    • This can be a result of incorrect positioning, inadequate pressure from a pump, or restriction of milk flow from poorly fitting bras or any kind of breast trauma that damages the duct. Fatigue, stress, or failure of the baby to latch on properly can also contribute to this problem.
    • Standard Treatment consists of moist heat beforehand for approximately 5 minutes, empty breast as much as possible, cool compresses afterwards, and reduce swelling in between feedings. Massaging the duct towards the nipple may also be helpful. If the plug comes out, it may look like dried milk in a string. One should continue to nurse to fully clear the plug. Apply cold compresses via an ice pack or a plastic bag of frozen peas for approximately 15 to 20 minutes. Fresh cabbage leaves to the area is another herbal remedy that can be used in between feedings to help with engorgement. Cabbage leaves can be left in the bra for approximately one hour until it wilts. It is important to avoid the nipple area when applying the cabbage leaf because the cabbage is caustic and can cause irritation.
    • Other helpful treatments include:
  4. What do I do if the baby does not latch on?
    Latch problems can depend upon the situation causing them:

    1. It may be due to a newborn who is just learning how to latch.
      Assistance from a lactation consultant can be very helpful in making sure the baby is latched deeply with a mouth very wide to get all the breast tissue. The baby should be latched well beyond the tip of the nipple. Often latching problems occur because the baby fails to flare the bottom lip.
    2. Is it due to flat or inverted nipples?
      If the problem is due to flat or inverted nipples, a suction device, pump, or nipple shield may be used to avoid engorgement by expressing the milk. This will avoid a lowered or disappearing milk supply. Different lactation consultants and hospitals may prefer one modality over another, however all agree that care has to be taken when using any device that serious trauma or damage does not occur to the nipple.Once the baby is “educated” that the breast is his or her “food supply”, generally the baby will nurse fine. It is helpful to try and get beyond the first few days when only colostrum is present, until the milk comes in. Try and avoid avoid artificial nipples at the very beginning.
    3. Is the baby not hungry at this time?
    4. Is there a nursing strike?
      A “nursing strike” can occur if a well nursing baby, beyond the newborn period suddenly refuses to nurse. This can occur often after 4 months of age when a mother will state “my seven month old baby just suddenly weaned herself.” These babies are not weaning but are actually facing a situation where nursing has become unpleasant, boring, or painful. Often these infants need to be taught to return to a functional breastfeeding pattern with increased skin to skin contact, trying to nurse in a quiet, calm environment without distractions, such as nursing at night in bed. Bottles should be avoided but spoon or cup feeding with expressed milk is acceptable. If the underlying cause is treated, most babies will happily go back to their normal nursing pattern.
  5. Is the baby getting sick?
    Causes of poor latch can be an undiagnosed ear infection, a urinary tract infection, or an upper respiratory infection. Check with your pediatrician to be sure an illness is not being missed. Maternal stress can also cause this problem.Regardless of the problem, it is important to remove the milk as efficiently as possible if an established supply exists to avoid engorgement which will lower or cause the milk supply to disappear.

    If the baby is not latching, it is important to stimulate the establishment of milk production through use of a pump.

  6. How do I wean the baby when I have decided to transfer to a bottle?
    Weaning is the time the baby transitions away from the breast. Time frames for weaning can vary from weeks to months.Slow weaning is always more optimal. Some mothers will use the pump for weaning and stop breastfeeding entirely. One option for weaning would be to reduce the time per pumping, ie instead of pumping for 15 minutes, reduce it to 10 minutes. This can gradually be dropped down to 2 to 3 minutes per session. An alternative way to wean is to increase the interval between pumping sessions, ie from every 3 hours to every 4, 6 or even 8 hours. If desired, one can use ice packs after pumping for comfort. Also, Motrin can be used for anti-inflammatory pain relief. A comfortable, tight bra can also help with support and relief. Nursing pads can be used to prevent excess leakage. A recommended herbal remedy can be drinking 3 cups of sage tea which is available in health food stores. It has a strong and astringent taste so adding honey makes it more palatable. Do not use this if currently pregnant since it has abortive action.

    On occasion, sudden weaning becomes necessary. Discomfort is generally greater since the breast continues to make milk and the breast remains engorged. Nursing can be replaced with pumping but only pump the breast to allow comfort and not to completely drain. Increase time frame between pumpings.

    Three days of Sudafed can help dry up the milk production. The milk supply decreases as you feed less. The milk quality also changes becoming more salty and colostrum-like which many babies do not like. Consequently, this also helps diminish the nursing.

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Choosing the Pump that's Right for You

Monday, August 23rd, 2010

Different Kinds of PumpsLet’s face it. A breast pump is not the most romantic, or glamorous, piece of equipment ever invented. They can be bulky and uncomfortable, hard to clean and very expensive. Even worse, when lifted out of their boxes, they may seem extremely intimidating to use on something as delicate as our breasts. Personally, I would rather spend this kind of money on a cute Kate Spade purse, or a nice pair of Gucci pumps… not a breast pump!

Does a breastfeeding woman really need one of these things?

The answer is maybe…

It’s a well known fact that breast feeding has significant benefits to both mother and baby. (Breast Feeding Experts Weigh in on SIDS)(Breastfeeding Cuts Breast Cancer Risk)(Breast Feeding Can Reduce the Risk of Heart Disease) Previous blogs discussed how over 60% of the 4 million pregnant women in America are currently employed and the majority will want to return to the workforce soon after delivery. (Is Pregnancy a Disability?)( Breastfeeding and the Law) This should not be a deterrent for breastfeeding and therefore, it becomes extremely important for women to be encouraged to continue to breastfeed their newborns in a safe, efficient, and effective way while still carrying on their daily work lives. Since women are not available for demand feeding, it becomes vital to know how to use a breast pump so another caregiver can provide milk for the newborn. The blog this week will deal with the nuances of choosing the correct breast pump.

Who should use a breast pump?

Learning how to use a pump is important in the following situations:

  1. Women returning to work and not available for feeding.
  2. Premature infants lacking a good suck reflex can benefit from breast milk that is pumped making it easier for them to feed.
  3. Mom is unable to breastfeed due to sickness.
  4. Infants having difficulty removing milk from the breast due to anatomy when other techniques to correct fail (flat or inverted nipples of the mom or a facial abnormality in the infant).

How does the breast pump work?

Pumping milk from the breast has its origins from the dairy industry in the 1950”s by Einar Egnell. Pumps have been designed to simulate the sucking action of a nursing infant by mimicking both the suction pressure and the frequency of a baby’s suckling. Pumps are designed so that the amount of pressure and the cycle frequency can be regulated by the mother.

The volume of expressed milk with a breast pump is higher compared to manual expression.

Pressure

The pump has to have enough pressure to extract milk from the breast but not so high that it causes pain and skin trauma. The pump relies on the physics of a fluid moving from an area of higher pressure to an area of of lower pressure. The breast pump creates a pressure differential with negative pressure on the breast reducing the resistance to the outflow of milk from the milk ducts of the mother, which is at a higher pressure. Babies breast feed with a suction pressure of 50–220 mm Hg so the pumps are designed to suck at maximum negative pressures at about 220–250 mm Hg. Levels at less that 150 mm Hg are ineffective in emptying the breast and pressures greater than 220 mm Hg cause nipple pain which will result in the mother terminating her breast feeding.

Pumps can vary in the configuration of the flange (cup applied to the breast). The smaller the cup, the more pressure is exerted over a smaller area of space.

Frequency

The other important factor is the length of time the vacuum is applied. Babies suck at a frequency of between 40 and 126 sucks per minute and pumps are designed to mimic the breast by pumping at 40–60 cycles per minute.

How do you select the proper breast pump?

There are so many pumps available today with countless cycle and suction settings, different sizes, power sources, single vs. double set-ups and varying prices that it becomes a great enigma in choosing the right one for an individual. Important considerations in choosing a breast pump include baby’s age, mother’s work needs (full time or part time), support from the mother’s work environment, mother’s finances,and family’s health insurance. Price differences can be based on the durability of the motor, length of the manufacturers warranty, style of packaging, personal amenities, and have single or double set-ups.

Talking with a lactation consultant before you leave the hospital can help you sort through the morass of information. Many pumps are generally not refundable once used so trialing in the hospital or through a lactation consultant may be a good idea. Here are some of the factors to consider when deciding .

Price

The cost of a breast pump is approximately 1,500 dollars for a hospital grade variety to about 150–350 dollars for a personal use style. Prices will increase depending upon the accessories that are packaged with it. Pumps can also be rented for from 30 to 75 dollars per month. but mothers will need to buy all the accessories which include bottles, tubing, and breast flanges for about 50 dollars. If plans are to pump for several months, it may be more valuable to purchase one. Personal breast pumps in the long run are cheaper than formula which can run over 2,000 dollars a year.

Single vs. double pumping

Bilateral pumping is quicker and use more powerful machines with greater cycles per minute and use more pressure to express a greater amount of milk in less time.

For women that use a single pump, the breast should be switched every 5 minutes. It may take 15 to 20 minutes as opposed to 10 minutes with a double pump.

Power source

Electric pumps produce the most milk, followed by battery operated pumps and finally hand pumps. Some pumps have car adapters. For a non-working mother who does occasional pumping, a hand pump or small battery operated pump can work well. Try to make sure the pump has a one year warranty on the motor.

Other factors to consider

Noise level, ease of use and assembly, and difficulty in cleaning are also variables that must be considered when choosing a breast pump. Also ease of obtaining spare parts is a consideration.

Other accessories

Some pumps have more discreet carrying cases to make for easy transport. Also some packages contain gel or ice packs to keep the milk cool.

Different Categories of Pumps

Hand pumps
Two different types exist:

Milk can be pumped from many kinds of mothers, this one has four spigots instead of two.

Milk can be pumped from many kinds of mothers. This one has four spigots instead of two.

  1. Cylinder pump—Has a double cylinder set-up with suction created by pushing and pulling one cylinder inside the other.
    The main problem can be the gasket inside which may need replacement because of shrinkage or its inability to maintain a seal after continued use. The gasket can also harbor bacteria.
  2. Hand squeeze pump— Suction is created with a hand lever that is squeezed and released.
    The advantage is that it is portable, easy to use, quick to assemble, no need for electricity, and is inexpensive.
    The disadvantage is the difficulty in obtaining a good milk supply due to difficulty in cycling at baby’s normal suck reflex. Many have a poor suction or excessive suction. Women can also fatigue easily with continued use, especially those with wrist problems or carpal tunnel syndrome (very common in pregnancy.)

Semi-automatic pumps

These pumps can be used manually, with a battery or with an electric adapter. The motor is generally small and not meant for frequent use.

The advantage is that they are portable, lightweight, small and do not require electricity. They can be double and often come with a cooler case.

The disadvantage is that they are not meant for heavy use and are not very durable. The short battery life can be expensive. The cycle frequency slows as the battery wears down. Some can also be noisy.

Personal use electric double pumps

These are automatic, light weight, durable, portable, and double-pump with controls to regulate the pressure and frequency for comfort. They generally include chill packs and storage compartments. They are run by electricity but can have battery and adapters included.

Hospital grade rentals

These are the most powerful and effective with different control settings for suction and frequency. They are the most expensive. Physically, they are large and heavy, and not meant to be portable. Therefore, there is no carrying case and no compartments for storing milk. They run on electricity. They are designed to be multi-user and you must supply your own collection kit which generally must match the pump brand.

Are there FDA standards for breast pumps?

In the United States, there are currently no standards for breast pumps to ensure the safety and quality of the products. However, the FDA does consider personal (not industrial) pumps to be used by one person only. Unfortunately certain pumps are impossible to clean and can produce high bacterial counts making a woman more prone to infection which is a reason not to buy or share a used personal pump.

Summary:
Choosing the right breast pump depends upon the individual needs of each mother. Factors to consider include the home and work situation, the amount of use, and cost factors. The assistance of a qualified lactation consultant is indispensable in guiding a new mom in choosing what works best for each given situation.

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Breastfeeding and the Law

Tuesday, August 10th, 2010

Breastfeeding and the LawEarlier this month, which happens to be Breastfeeding Month, the well-known model Gisele Bundchen ignited a firestorm of controversy regarding her opinion that breastfeeding should become a worldwide requirement by law.

Gisele, clearly passionate about being a new mother, may have over-reached a bit, but her heart was in the right place. She retracted her statement a few days later on her own blog, stating that she did not mean to say it should be a law but that she was just being enthusiastic and that the statement was taken out of context by the press and media outlets. I mention this because I think Gisele has advanced an important conversation regarding the workplace and expression of breast milk.

Gisele BundchinGisele Bundchen wrote on her blog. “My intention in making a comment about the importance of breastfeeding has nothing to do with the law. It comes from my passion and beliefs about children. Becoming a new mom has brought a lot of questions, I feel like I am in a constant search for answers on what might be the best for my child. It’s unfortunate that in an interview sometimes things can seem so black and white. I am sure if I would just be sitting talking about my experiences with other mothers, we would just be sharing opinions. I understand that everyone has their own experience and opinions and I am not here to judge. I believe that bringing a life into this world is the single most important thing a person can undertake and it can also be the most challenging. I think as mothers we are all just trying our best.”

http://blog.giselebundchen.com.br/en/sentido/a-importancia-da-amamentacao/

Last week I wrote about how to safely store your breast milk while working, or away from your baby, for any reason. This week, my article is about the many challenges women around the world face, both cultural and governmental, when trying to breastfeed their babies.

The month of August is Breast Awareness Month. The United States Department of Health and Human Services is sponsoring a campaign to encourage women to breastfeed. Despite all of the articles and books promoting the importance of optimizing infant health by breastfeeding, 70% of women will start breastfeeding immediately after delivery, and fewer than 20% will still be breastfeeding 6 months later. There still exist numerous cultural and legal barriers that make it very difficult for mothers to exclusively breastfeed. Women often feel nervous and embarrassed when breastfeeding in public and this will often result in abandoning breastfeeding.

A well known legal case in 1981 (Dike v. The School Board) is a perfect example of a discriminating situation that breastfeeding mothers may face.

Case Study

Janice Dike was a grade school teacher in Orange County, florida, who was banned from breastfeeding her child during her free lunch period. She claimed that her breastfeeding did not interfere with her teaching or her other school and work activities. The local court ruled against her, saying that it was illegal to breastfeed at the school. On appeal to the Fifth Circuit Court of Appeals, this decision was reversed. The decision stated that breastfeeding is a Constitutional right that cannot be restricted by the states. However, this ruling was again reversed in the case of Shahar v Bowers (1997) in which the Court stated that the Constitution does not address private conduct but rather that State laws should control a woman’s basic right to breast feed her child.

What are the current laws?

There are Federal laws and State laws that protect the rights of breastfeeding mothers and provide a socially supportive environment. Mothers must be aware of the legislation that exists in their particular state to avoid feelings of discrimination and to alleviate any anxiety they may have in public places. States vary in their protection of women.

  • Forty-four states (and the District of Columbia and the Virgin Islands) have laws specifically allowing women to breastfeed in public and private places.
  • Twenty eight states (including the district of Columbia and the Virgin Islands) have specific laws exempting breastfeeding from public indecency laws.
  • Twenty four states (including the District of Columbia and Puerto Rico) have laws that protect women when breastfeeding in the workplace.
  • Twelve states (including Puerto Rico) exempt breastfeeding women from jury duty.
  • Five states and Puerto Rico have breastfeeding education campaigns.
  • Individual states also have unique laws. Places like New Jersey and Hawaii allow a woman to seek legal recourse if she is unfairly discriminated against for public breastfeeding and states like Missouri allow breastfeeding only in certain locations and times and with appropriate discretion.
  • Women are permitted to feed in any federal owned building or property, regardless of state (passed in 1999).
  • Only Virginia allows women to breastfeed on any land or property owned by the State.

In my own state, Connecticut, there is a law that protects a woman’s right to breastfeed her child in any public place and employers must allow you to breastfeed or express milk at work, even if it is a very small firm. This means that your employer must allow you to breastfeed or express milk during your meal or break period and your employer must make a reasonable effort to provide a room or comfortable location to do this (not a toilet stall).

Federal Laws

In March 2010, President Obama signed the Patient Protection and Affordable Care Act which now requires an employer to provide reasonable break time for an employee to express milk for the purposes of nursing or expressing milk for her child for one year. The employer has no obligation to compensate the employee for this time. The employer must also provide a reasonable space to do this (not a bathroom). An employer of fewer than 50 employees is are not required to do this if it imposes undue hardship. Also, this law is not meant to preempt any state law that provides even greater protection for a nursing employee.
In the past, other bills have been proposed in Congress to try to protect breastfeeding rights that provide for tax incentives for businesses to create lactation lounges for employees, minimum standards for quality control for breast pumps, and tax deductions for breastfeeding equipment and services. However, these proposals have not been passed.

US Policy on Breastfeeding

In the larger arena, in world policy, the United States has not been considered one of the world leaders in policy to promote breastfeeding.
Important international policies in the past included:

  • The UN convention in 1989 on the Rights of the Child which was ratified by every country in the world except the United States and Somalia. This convention provided a basis for governments, international agencies and other organizations to formulate programs to provide for supporting, promoting, and protecting breastfeeding.
  • In 1989, WHO and UNICEF issued a joint statement entitled Protection, Promotion, and Support of breastfeeding: Ten Steps to successful Breastfeeding that calls on hospitals and health care facilities to adopt practices to encourage and promote breastfeeding.
  • 1990, The Innocenti Declaration was created by participants of WHO/UNICEF policy makers meeting on breastfeeding held in Florence Italy that set targets for governments to implement by 1995 for establishing national breastfeeding coordinators and committees and ensuring appropriate maternity services protecting the breastfeeding rights of working women.
  • The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 by WHO and UNICEF to call for action for all maternity services, freestanding or hospital-based, to become centers for excellence in breastfeeding support. Accreditation is granted when a center doesn’t accept free or low cost breast milk substitutes, does not provide feeding bottles or artificial nipples and has implemented the ten step program to support breastfeeding. As of 2007 there were only 56 hospitals and birthing centers in the US holding the BabyFriendly certificate.
  • The United States breastfeeding Committee was established in 1998 (USBC) which works on advocacy issues at the Federal level. This is a group of 40 organizations which promote, protect, and support breastfeeding in the United States by focusing on national policy issues. The Committee attempts to promote implementation of the Innocenti goals of 1990 for establishing a national breastfeeding committee.
  • In 2001 the United States Surgeon General issued the HHS Blueprint for Action on breastfeeding to encourage, market and support breastfeeding in the community and allow for the health care system of the US to support the training of health care professionals on the basics of lactation counseling and management within hospitals and maternity centers, and to support facilitation of breastfeeding for women who return to the workplace.

For woman facing discrimination, complaints can be filed with the National Alliance for Breastfeeding Advocacy (http://www.naba-breastfeeding.org/).

The LaLeche League International (LLLI) is also a valuable source for breastfeeding legislation. In addition, www.ncsl.org is a good resource for reviewing your particular states legislation on breastfeeding.

Conclusion

Breastfeeding a newborn infant is considered a mother’s basic human right, to provide for a child’s right to proper nutrition, health and care. The various countries have their own cultural, social, economic, and political norms, but basic protection guaranteed by government is essential to support women’s rights in this area. With recent legislation under President Obama, the United States is finally trying to catch up by providing legal and social support to improve national objectives for increasing the percentage of breastfeeding to 75% at birth, 50% at 6 months and 25% at one year of life.

Even in the US, we have such a long way to go in terms of acceptance of this very natural and beautiful practice. Please take the time to learn the facts so you can participate in conversations about breastfeeding law, whether you be at work, in a social situation, or even while helping others learn how to successfully breastfeed. If you are a physician or lactation consultant, please know that this is the most recent research available.

If anyone has any more suggestions to help mothers breastfeed longer, please post them in the comments section below and let’s get a conversation going about this very controversial topic.

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The information provided in these articles and on this website is intended for educational and informational purposes only.
This information should not be used in place of an individual consultation or examination or replace the advice of your medical professional,
and should not be relied upon to determine diagnosis or course of treatment.
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