- Email: [email protected]
What to know when choosing a breast pump
PH C
DEPARTMENT
SECTION EDITOR Ju a n i t a C o n k i n D a l e , P h D, R N , C P N P C h i l d re n ’s M e d i c a l C e n t e r o f D a l l a s D a l l a s , Tex a s
PRODUCT SHOWCASE
What to Know When Choosing a Breast Pump
Ju a n i t a C o n k i n D a l e , P h D, R N , C P N P
A
ccording to the Position Statement on Breastfeeding, one of the goals of the National Association of Pediatric Nurse Practitioners (NAPNAP) is to enhance the quality of health care for all children. Thus NAPNAP encourages nutritional practices that contribute to optimum child health, growth and development. Breastfeeding is identified by NAPNAP as the natural and preferred method of infant feeding. Also, human milk is considered superior to all substitute feeding options (NAPNAP, 2001). The Pediatric Nurse Practitioner (PNP) can support the mother’s decision to breastfeed by providing accurate and current information about the benefits of breastfeeding and ways to eliminate barriers (NAPNAP, 2001). Breastfeeding is known to benefit the baby by decreasing the number of ear and respiratory infections, protecting against Sudden Infant Death Syndrome (SIDS), decreasing allergies, and reducing medical costs for both the mother and baby. The benefits for the mother include fewer incidences of premenopausal ovarian and breast cancer, the ability to eat more while potentially losing weight, savings on formula cost, strong bonding of mother and baby, and less time missed from work because of improved health of baby (Office of Personnel Management, 2003). When a breastfeeding mother returns to work, she may choose to com-
338
B
reastfeeding is known
to benefit the baby by decreasing the number of ear and respiratory infections, protecting against Sudden Infant Death Syndrome (SIDS), decreasing allergies, and reducing medical costs for both the mother and baby.
bine breastfeeding with formula-feeding by nursing before and after work
and on her days off, or she may choose to breastfeed exclusively (Office of Personnel Management, 2003). A breastfeeding mother may need to pump her breasts to provide milk if the baby is premature or ill. In these situations, a breast pump will not only be convenient, it will be a necessity. There are two basic choices in breast pumps—manual and automatic (see Tables 1 & 2 for partial list). Manual pumps are very portable and easy to clean but are slower. They only let the mother pump one breast at a time. Automatic pumps are much more expensive. However, they can be rented from a hospital or medical supply store for $2 to $4 a day plus the cost of the accessories. Some automatic pumps can be very noisy. Automatic battery-operated pumps are faster than manual pumps, but are not as efficient as electric pumps (Consumer Federation of America Foundation, 2003). The most popular manual pumps are either piston or cylinder pumps. The pump consists of two cylinders, one inside the other, with a cup that fits over the mother’s breast. These pumps are
Reprint requests: Juanita Conkin Dale, PhD, RN, CPNP, Center for Cancer and Blood Disorders, Children’s Medical Center of Dallas, 1935 Motor Street, Dallas, TX 75235; fax: 214-456-8469; e-mail: [email protected] J Pediatr Health Care (2003). 17, 338-340. Copyright © 2003 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2003/$30.00 + 0 doi:10.1016/mph.2003.85
November/December 2003
PH PRODUCT SHOWCASE C easy to use and dishwasher safe. They are small enough to carry to and from work. Cylinder pumps usually come with two adapters for varying nipple sizes. The cylinder can double as a baby bottle. Convertible pumps use a pistontype pumping action. They include an adapter for an electric breast pump (Consumer Federation of America Foundation, 2003). Electric pumps are easier to use and may empty the mother’s breast more thoroughly. This is helpful in maintaining the milk supply. The suction can be adjusted to imitate the baby’s sucking patterns. Milk can be expressed from both breasts at the same time. They pump the milk faster than a manual pump, thus increasing milk production. However, they can be heavy, bulky, and expensive (Consumer Federation of America Foundation, 2003). Electric portable pumps, which are smaller than institutional style pumps, may sacrifice in the amount of suction they provide. Yet, some are fully automatic and usually weigh less than eight pounds. These pumps have quick cycling times, adjustable sucking levels, and double-pumping action. A little more effort and time is required for semi-automatic breast pumps than for fully automatic electric models. These pumps usually weigh less than two pounds and are less expensive. For semi-automatic pumps, the mother is required to create the rhythm of nursing by lifting or rolling a finger over a hole. Semi-automatic pumps have medium cycle times, adjustable suction, and double pumping capabilities (Consumer Federation of America Foundation, 2003). Battery-operated pumps do not create as much suction as a regular electric pump. However, they are very transportable and less expensive. Some negative features for these pumps are that suction is difficult to control, and only one breast can be pumped at a time (Consumer Federation of America Foundation, 2003). When deciding which pump to buy, the mother should consider points such as ease of cleaning, assembly, use, and carrying. Using a pump with double pumping capabilities can cut the time in half and increase the milk production. Acceptable level of suction will vary from one mother to the next, so choosing a pump with adjustable vac-
JOURNAL OF PEDIATRIC HEALTH CARE
Dale
TABLE 1 Overview of Breast Pumps—Electric/Battery Model
Manufacturers
Battery/Electric Breast Pump Kit Gerber Breast Expresser® Breast Pump Whittlestone Double Deluxe Breast Pump Medela DoubleEase® Breast Pump & Carry-All† Medela Double Pumping Kit Medela Electric/Battery Breast Pump Kit The First Years Elite® Hollister Lact-e®‡ Hollister Gentle Expressions® AC Adapter Breast Luminscope Pump Model 510604† Mini Electric® Breast Pump† Medela Nurture III® Double Breast Pump‡ Bailey Medical with Tote Personal Comfort® Automatically Evenflo Cycling Dual Breast Pump Press & Pump® Battery/Electric Evenflo Breast Pump Pump in Style® Companion† Medela Pump in Style® Traveler with Battery Pack† Medela Purely Yours® Breast Pump† with Ameda Egnell/ Hollister Carry-All SMB® Breast Pump‡ Hollister
Price*
$49.98 $297.50-350.00 $130 $149.95-179.95 $279.99 $54.00 $24.98 $60.39-78.95 $120.65-142.20 $84.99-99.95 $42.99-59.99 $251.95-289.95 $251.95-279.95 $179.99-219.95
* Prices listed were obtained from various Web sites on August 1, 2003. † Labeled as “single user” devices. ‡ Designed to be used by multiple users.
TABLE 2 Overview of Breast Pumps—Manual and/or Electric* Model
Manufacturer
Breast Pump Avent Breast Pump Gerber Breast Pump Back-to-Work Avent ComfortEase® Manual Breast Pump Evenflo Isis® Manual Breast Pump† Avent Lactina® Select‡ Medela Lansinoh Breastfeeding Collection One-Hand Pump Ameda Manual Breast Gerber Manual Breast Pump Kit Evenflo ManualEase® Medela Manualectric® Medela Natural Comfort Breast Pump 1075® The First Years Pedal Pump Medela Spring Express® Medela Spring Express® Manual Pump 67103 Medela
Price*
$36.50-42.95 $53.00 $55.00 $19.98 $90.00 $69.95 $18.00 $17.98 $45.00 $98.00 $45.00 $277.00 $60.00 $27.00
*Prices listed were obtained from various Web sites on August 1, 2003. †Labeled as “single user” devices. ‡Designed to be used by multiple users.
uum allows the mother to have the amount of suction that is comfortable for her. The insurance company may pay for the pump if the health care provider writes a prescription for the
pump (Consumer Federation of America Foundation, 2003). Because a used pump is more affordable than a new pump, many breastfeeding mothers may consider purchas-
November/December 2003
339
PH PRODUCT SHOWCASE C ing a used pump. However, there are some real health considerations involved. Some organisms are known to be present in the breast milk of an infected woman. Blood contamination may have occurred if a mother used the breast pump during an episode of cracked, bleeding nipples. Home sterilization methods may not ensure the destruction of all pathogens especially in the rubber parts of the pump such as the washers and diaphragm. Most single user pumps do not have a protective barrier to prevent cross contamination to multiple users because they are an “open system” (Curtis, 2001). Information is included in Tables 1 and 2 regarding some pumps that are labeled as single user (open system) devices versus multiple user (closed system) devices. The PNP or breastfeeding mother may access some information about the various breast pumps and acces-
340
Volume 17 Number 6
Dale
sories available through several Web sites including http://www.epinions.com, http://store.baby.com, and http://www.babygenie.com. These
T
he most popular
manual pumps are either piston or cylinder pumps.
Web sites also provide price comparisons and customer reviews with the pros and cons of the various products. PNPs can have a significant impact on breastfeeding practices by sup-
porting the breastfeeding efforts of their patients (NAPNAP, 2001). If the PNP has a knowledge base about breastfeeding pumps and equipment that is available, he or she can share this information with the breastfeeding mother.
REFERENCES Consumer Federation of America Foundation, (2003). Breast pumps. Retrieved August 1, 2003, from http://www.safechild.net/for_ parents/breastpumps.html Curtis, C. (2001). Used breast pumps. Retrieved August 1, 2003 from http://www. breastfeedingonline.com/pumps-print.html National Association of Pediatric Nurse Practitioners. (2001). NAPNAP Position Statement on Breastfeeding. Retrieved August 8, 2003 from http://www.napnap.org/positions/ breastfeeding.html U. S. Office of Personnel. (2003). Establishing a nursing mother’s program. Retrieved August 1, 2003, from http://www.opm.gov/wrkfam/html/nursing.asp
JOURNAL OF PEDIATRIC HEALTH CARE
DEPARTMENT
SECTION EDITOR Ju a n i t a C o n k i n D a l e , P h D, R N , C P N P C h i l d re n ’s M e d i c a l C e n t e r o f D a l l a s D a l l a s , Tex a s
PRODUCT SHOWCASE
What to Know When Choosing a Breast Pump
Ju a n i t a C o n k i n D a l e , P h D, R N , C P N P
A
ccording to the Position Statement on Breastfeeding, one of the goals of the National Association of Pediatric Nurse Practitioners (NAPNAP) is to enhance the quality of health care for all children. Thus NAPNAP encourages nutritional practices that contribute to optimum child health, growth and development. Breastfeeding is identified by NAPNAP as the natural and preferred method of infant feeding. Also, human milk is considered superior to all substitute feeding options (NAPNAP, 2001). The Pediatric Nurse Practitioner (PNP) can support the mother’s decision to breastfeed by providing accurate and current information about the benefits of breastfeeding and ways to eliminate barriers (NAPNAP, 2001). Breastfeeding is known to benefit the baby by decreasing the number of ear and respiratory infections, protecting against Sudden Infant Death Syndrome (SIDS), decreasing allergies, and reducing medical costs for both the mother and baby. The benefits for the mother include fewer incidences of premenopausal ovarian and breast cancer, the ability to eat more while potentially losing weight, savings on formula cost, strong bonding of mother and baby, and less time missed from work because of improved health of baby (Office of Personnel Management, 2003). When a breastfeeding mother returns to work, she may choose to com-
338
B
reastfeeding is known
to benefit the baby by decreasing the number of ear and respiratory infections, protecting against Sudden Infant Death Syndrome (SIDS), decreasing allergies, and reducing medical costs for both the mother and baby.
bine breastfeeding with formula-feeding by nursing before and after work
and on her days off, or she may choose to breastfeed exclusively (Office of Personnel Management, 2003). A breastfeeding mother may need to pump her breasts to provide milk if the baby is premature or ill. In these situations, a breast pump will not only be convenient, it will be a necessity. There are two basic choices in breast pumps—manual and automatic (see Tables 1 & 2 for partial list). Manual pumps are very portable and easy to clean but are slower. They only let the mother pump one breast at a time. Automatic pumps are much more expensive. However, they can be rented from a hospital or medical supply store for $2 to $4 a day plus the cost of the accessories. Some automatic pumps can be very noisy. Automatic battery-operated pumps are faster than manual pumps, but are not as efficient as electric pumps (Consumer Federation of America Foundation, 2003). The most popular manual pumps are either piston or cylinder pumps. The pump consists of two cylinders, one inside the other, with a cup that fits over the mother’s breast. These pumps are
Reprint requests: Juanita Conkin Dale, PhD, RN, CPNP, Center for Cancer and Blood Disorders, Children’s Medical Center of Dallas, 1935 Motor Street, Dallas, TX 75235; fax: 214-456-8469; e-mail: [email protected] J Pediatr Health Care (2003). 17, 338-340. Copyright © 2003 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2003/$30.00 + 0 doi:10.1016/mph.2003.85
November/December 2003
PH PRODUCT SHOWCASE C easy to use and dishwasher safe. They are small enough to carry to and from work. Cylinder pumps usually come with two adapters for varying nipple sizes. The cylinder can double as a baby bottle. Convertible pumps use a pistontype pumping action. They include an adapter for an electric breast pump (Consumer Federation of America Foundation, 2003). Electric pumps are easier to use and may empty the mother’s breast more thoroughly. This is helpful in maintaining the milk supply. The suction can be adjusted to imitate the baby’s sucking patterns. Milk can be expressed from both breasts at the same time. They pump the milk faster than a manual pump, thus increasing milk production. However, they can be heavy, bulky, and expensive (Consumer Federation of America Foundation, 2003). Electric portable pumps, which are smaller than institutional style pumps, may sacrifice in the amount of suction they provide. Yet, some are fully automatic and usually weigh less than eight pounds. These pumps have quick cycling times, adjustable sucking levels, and double-pumping action. A little more effort and time is required for semi-automatic breast pumps than for fully automatic electric models. These pumps usually weigh less than two pounds and are less expensive. For semi-automatic pumps, the mother is required to create the rhythm of nursing by lifting or rolling a finger over a hole. Semi-automatic pumps have medium cycle times, adjustable suction, and double pumping capabilities (Consumer Federation of America Foundation, 2003). Battery-operated pumps do not create as much suction as a regular electric pump. However, they are very transportable and less expensive. Some negative features for these pumps are that suction is difficult to control, and only one breast can be pumped at a time (Consumer Federation of America Foundation, 2003). When deciding which pump to buy, the mother should consider points such as ease of cleaning, assembly, use, and carrying. Using a pump with double pumping capabilities can cut the time in half and increase the milk production. Acceptable level of suction will vary from one mother to the next, so choosing a pump with adjustable vac-
JOURNAL OF PEDIATRIC HEALTH CARE
Dale
TABLE 1 Overview of Breast Pumps—Electric/Battery Model
Manufacturers
Battery/Electric Breast Pump Kit Gerber Breast Expresser® Breast Pump Whittlestone Double Deluxe Breast Pump Medela DoubleEase® Breast Pump & Carry-All† Medela Double Pumping Kit Medela Electric/Battery Breast Pump Kit The First Years Elite® Hollister Lact-e®‡ Hollister Gentle Expressions® AC Adapter Breast Luminscope Pump Model 510604† Mini Electric® Breast Pump† Medela Nurture III® Double Breast Pump‡ Bailey Medical with Tote Personal Comfort® Automatically Evenflo Cycling Dual Breast Pump Press & Pump® Battery/Electric Evenflo Breast Pump Pump in Style® Companion† Medela Pump in Style® Traveler with Battery Pack† Medela Purely Yours® Breast Pump† with Ameda Egnell/ Hollister Carry-All SMB® Breast Pump‡ Hollister
Price*
$49.98 $297.50-350.00 $130 $149.95-179.95 $279.99 $54.00 $24.98 $60.39-78.95 $120.65-142.20 $84.99-99.95 $42.99-59.99 $251.95-289.95 $251.95-279.95 $179.99-219.95
* Prices listed were obtained from various Web sites on August 1, 2003. † Labeled as “single user” devices. ‡ Designed to be used by multiple users.
TABLE 2 Overview of Breast Pumps—Manual and/or Electric* Model
Manufacturer
Breast Pump Avent Breast Pump Gerber Breast Pump Back-to-Work Avent ComfortEase® Manual Breast Pump Evenflo Isis® Manual Breast Pump† Avent Lactina® Select‡ Medela Lansinoh Breastfeeding Collection One-Hand Pump Ameda Manual Breast Gerber Manual Breast Pump Kit Evenflo ManualEase® Medela Manualectric® Medela Natural Comfort Breast Pump 1075® The First Years Pedal Pump Medela Spring Express® Medela Spring Express® Manual Pump 67103 Medela
Price*
$36.50-42.95 $53.00 $55.00 $19.98 $90.00 $69.95 $18.00 $17.98 $45.00 $98.00 $45.00 $277.00 $60.00 $27.00
*Prices listed were obtained from various Web sites on August 1, 2003. †Labeled as “single user” devices. ‡Designed to be used by multiple users.
uum allows the mother to have the amount of suction that is comfortable for her. The insurance company may pay for the pump if the health care provider writes a prescription for the
pump (Consumer Federation of America Foundation, 2003). Because a used pump is more affordable than a new pump, many breastfeeding mothers may consider purchas-
November/December 2003
339
PH PRODUCT SHOWCASE C ing a used pump. However, there are some real health considerations involved. Some organisms are known to be present in the breast milk of an infected woman. Blood contamination may have occurred if a mother used the breast pump during an episode of cracked, bleeding nipples. Home sterilization methods may not ensure the destruction of all pathogens especially in the rubber parts of the pump such as the washers and diaphragm. Most single user pumps do not have a protective barrier to prevent cross contamination to multiple users because they are an “open system” (Curtis, 2001). Information is included in Tables 1 and 2 regarding some pumps that are labeled as single user (open system) devices versus multiple user (closed system) devices. The PNP or breastfeeding mother may access some information about the various breast pumps and acces-
340
Volume 17 Number 6
Dale
sories available through several Web sites including http://www.epinions.com, http://store.baby.com, and http://www.babygenie.com. These
T
he most popular
manual pumps are either piston or cylinder pumps.
Web sites also provide price comparisons and customer reviews with the pros and cons of the various products. PNPs can have a significant impact on breastfeeding practices by sup-
porting the breastfeeding efforts of their patients (NAPNAP, 2001). If the PNP has a knowledge base about breastfeeding pumps and equipment that is available, he or she can share this information with the breastfeeding mother.
REFERENCES Consumer Federation of America Foundation, (2003). Breast pumps. Retrieved August 1, 2003, from http://www.safechild.net/for_ parents/breastpumps.html Curtis, C. (2001). Used breast pumps. Retrieved August 1, 2003 from http://www. breastfeedingonline.com/pumps-print.html National Association of Pediatric Nurse Practitioners. (2001). NAPNAP Position Statement on Breastfeeding. Retrieved August 8, 2003 from http://www.napnap.org/positions/ breastfeeding.html U. S. Office of Personnel. (2003). Establishing a nursing mother’s program. Retrieved August 1, 2003, from http://www.opm.gov/wrkfam/html/nursing.asp
JOURNAL OF PEDIATRIC HEALTH CARE