Low Milk Supply -- Best Pump

Physical Methods | Medicinal Methods (Galactagogues)

Pump Types and Brands

There are many types of breast pumps available to nursing mothers, through both rental and purchase.

Rental grade electric pumps are built for both performance and endurance over many years. They are considered multi-user pumps; each new user purchases her own kit to attach to the pump motor. Rental grade pumps are auto-cycling and have adjustable vacuum suction; some models also have adjustable cycling speeds. All are commonly found in hospitals and rental depots but are rarely purchased by consumers because they range in price from US $700 to $2000. Rental rates can vary tremendously and often range from US $40 to $80 a month, depending upon the model, the rental station, and the length of the rental contract. Personal kits are sold separately. (Note: Always use the kit that matches the pump that is being rented; they are not interchangeable. Using one brand of kit with another brand of pump can result in excessive suction and trauma to your nipples, or inadequate suction and poor milk removal.)

Consumer grade electric pumps are usually considered single-user items and range from highly effective pumps that can last one or more years under heavy use to light duty pumps intended only for occasional use (a few times a week). The best pumps are usually warranted for at least a year, while lighter duty pumps carry an average warranty of 90 days. The higher-end pumps are equipped to handle dual pumping at full suction. Lighter- duty pumps may be single or dual pumping, but have lower suction with the dual pumping setting. To the undiscriminating buyer, all dual pumps may seem capable of the same performance, but they are not. It pays to do your homework.

What is the Best Kind of Pump to Use to Make More Milk?

To be effective, a good pump will have a proper balance of range in both suction strength and cycling speed to approximate the sucking of a baby. Pumps that reach their pressure too quickly cause tissue damage, as can those that take too much time to build up to the appropriate pressure. The proper balance is crucial.(1) Some of the high-end consumer-grade pumps claim to have similar specifications to rental grade pumps, but differ in their endurance and longevity. Mothers almost universally find that they are able to extract milk more easily and quickly with rental grade pumps than with even the best consumer-grade pumps.

Almost as important as the pump motor’s specifications is the breast flange kit that is paired with it. Breast flanges, also known as “breastshields,” are the parts that fit against mother’s breast. They have different tunnel diameters and depths that fit mothers differently. Each manufacturer has a standard size made for what they consider to be the “average” mother; Medela and Hollister also offer smaller and larger flange diameters to accommodate mothers who are not average. Other factors that determine the fit and comfort of a flange are a mother’s nipple length and areolar tissue elasticity.

One of the newest pump innovations has been the development of individualized pump flanges that are fitted according to the width of mothers’ nipples. Having a flange that is sized appropriately for your breasts can make a big difference in the comfort and effectiveness of a pump. If the flange diameter is too small, the nipple may rub against the sides of the flange and cause friction soreness, nipple color change, or nipple swelling. A flange diameter that is too large may pull in more than just the nipple and a little areola, especially if mother’s breast tissue is very elastic. This, too, can cause nipple swelling and redness. Most importantly, a flange that is too small can result in removal of less milk because the ducts inside the nipple are compressed too tightly.

Lactation consultants consistently find that most mothers require larger flanges than those supplied with standard pumps and pump kits. Susan Burger, MHS, PhD, IBCLC, has observed that nipples can expand greatly after five minutes of pumping. Therefore, she recommends that mothers evaluate their nipples several minutes after pumping to determine the correct fit. She believes that the "large" 27 mm Medela flanges are really "medium," not "large," and the "extra-large" 30 mm flanges are simply "large.” At the same time, she has seen that some mothers have very stretchy breasts that rub so much that they feel better with the smallest flange. In a study about factors affecting pump effectiveness, however, most mothers found that the larger flange sizes allowed them to pump more comfortably and effectively.

To know if the flange you are using is a good fit for your breast, watch the way your nipple draws into the flange tunnel as you pump. It is normal for the nipple to touch the sides of the tunnel, but it should move very easily and you should be able to see your areola moving slightly, as well. Sometimes a small amount of olive oil can lubricate the tunnel and alleviate friction, but a properly sized flange should not require it. When you remove the flange after pumping, look for any marks or redness on the areola or at the base of the nipple; these are signs that the flange is too small. If you decide you need a larger flange size, try the next larger size first and then try an even larger size next (if you pump manufacturer makes one). A lactation specialist or pump rental representative can also help you find the correct size flange for your breast/nipple combination.

Another option are the “soft” flanges made of flexible silicone. Some mothers find that they are more comfortable and result in higher milk output than the standard hard plastic flanges. Medela’s version is the SoftFit™, Ameda’s is the Flexishield™. The Avent Isis hand pump has a standard petal massager insert, while the Whittlestone SoftAire™ (also marketed as the Dr. Brown’s Natural Flow) is a soft honeycomb. PJ’s Comfort has a flexible silicone flange while the Playtex Embrace is semi-flexible inside a hard plastic flange.

Safety and Efficiency

The safest and most efficient electric breast pumps are auto-cycling, reaching a maximum suction that you set and then automatically releasing the pressure at selected intervals. Manually-cycled pumps come in two versions. The first will start to build pressure as soon as the breast is placed in it and will not stop until the mother presses a button or lever to release the suction; many mothers have inadvertently been hurt by these pumps when they did not understand the pumps’ operation. The second version will not build suction until the mother covers an air hole or holds something down; when she lets go, the suction releases. This second type of pump can be effective if paired with a motor capable of the appropriate range of suction and if the mother is able to develop an effective cycling pattern, but manually cycled pumps are usually not as efficient and effective as those that are auto-cycling.

What About Manual Pumps?

Manual pumps existed before electric pumps and have been used to initiate, maintain, and/or increase milk production. Most mothers find electric pumps to be more efficient and effective, but if necessary, a good manual pump can be used, and in fact may be more effective than a poor-quality, inexpensive electric or battery-operated pump. There are many on the market, including a few of the old bulb-syringe type that probably hurt more mothers than it helped. The best of these hand pumps include the Ameda One-Hand pump; the Medela Harmony one-hand pump; the Avent Isis one-hand pump with soft petal flange; the Whittlestone SoftAire/Dr. Brown’s Natural Flow, Evenflo’s ComfortCare and ComfortEase, and Gerber’s Massaging Manual Breast Pump. These particular manual pumps have a good track record. If you use a hand-pump, consider the design as each requires a different hand or arm action that can make a difference to someone with carpal tunnel syndrome or other physical limitations.

To Rent or to Buy?

As mentioned above, rental grade pumps are considered the first choice when it is necessary to pump to increase milk production and are our recommendation. The next best option is to purchase a higher-end consumer grade heavy use pump like the Medela Pump in Style or Ameda Purely Yours. As tempting as it may be to cut corners and purchase a cheaper pump, it is important to remember that smaller pumps are made for lighter use under normal supply conditions and wear out quickly, often in a matter of weeks or months, when used frequently. They are also usually not as efficient. Check the warranty to get an idea of the expected life of any pump you are considering. Use of a rental grade or high quality consumer grade pump is very cost-effective when compared to the cost of formula use (which averages US $1200 to $1600 per year).(2)

There is no question that mothers must make difficult economic choices that prevent them from purchasing or renting the higher quality, more expensive pumps. However, investing in the tools necessary to maximize your milk production now will likely be far less expensive than the cost of formula supplementation and additional medical care in the long run. A serious approach to increasing milk production may mean a serious approach to the tools that you use. On the other hand, while it is best to use the highest quality pump, not all mothers have this option. Some mothers effectively use hand-expression to remove their milk or stimulate their milk production. Anything you can do is better than doing nothing at all.

Note: Mothers in the US who qualify for the WIC or Medicaid programs may be able to obtain pumps at little or no cost. Many insurance companies are also beginning to cover breast pump rentals for medical situations, one of which is low milk production. Medela and Ameda/Hollister provide pumps to some low-income mothers through grant programs. Contact the appropriate agencies or companies directly for more information.

Used Pumps

It is not usual for mothers to see pumps offered for sale at yard sales and online resale sites like eBay. At first, it can seem like a great bargain to be able to get such an expensive pump for much less money than buying it new. Sometimes sisters and friends “hand down” pumps to new mothers. There are two significant problems with used pumps: they can be contaminated with bacteria, mold, and viruses; and they may not operate correctly so that they don’t remove as much milk as a new model.

For these reasons, most breast pump manufacturers recommend that personal use pumps, such as the Medela Pump in Style and the Ameda Purely Yours pumps, should not be shared between mothers. (Limerick’s PJ’s Comfort Jr. and Bailey’s Nurture III are exceptions with their FDA multi-user rating.) With the Pump in Style, the connection between the flange, milk, and the pump diaphragm is open, which could potentially allow contact of bacteria, mold, and certain viruses that can be transmited through the tubing and pump diaphragm into the milk that your baby drinks. Like all Ameda pumps, the Purely Yours is a closed system, but is still recommended for single users only.

The other major concern for all consumer-grade pumps is that they can slow down as they wear out, rather than just quit. Many mothers, especially first-time pumpers, may not be aware that their used pump is no longer performing at its peak, assuming instead that the problem is with their bodies. Low milk supplies are simply too vulnerable; why take a chance and waste your hard work by using a pump that may no longer perform well? A final concern with recycled equipment is that mothers have been known to borrow pumps, only to have them wear out, and then feel obligated to purchase a new replacement for the lender. Wouldn’t you rather spend that money on your own efficient equipment?

(1) Mitoulas, L., Lai, C., Gurrin, L., et al. Effect of vacuum profile on breast milk expression using an electric breast pump. J Hum Lact 2002; 18(4):353-360.

(2) Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book, 3rd Rev Ed. Schaumburg, IL: LLLI, 2003; 648.