Breast pump buying guide

You can refrigerate breast milk safely for 24 hours, or freeze it for three to six months. But when you put breast milk on a shelf and let it sit, the fats may begin to break down and a few of the many other components may begin to change, according to Miriam H. Labbok, M.D., M.P.H., director of the Carolina Breastfeeding Institute at the University of North Carolina at Chapel Hill. So use expressed milk as soon as possible, with the oldest milk first.

A housekeeping note: Always refrigerate expressed milk as soon as possible. When you're away from home, use an insulated container packed with ice or frozen ice packs to keep your breast milk cool. When freezing breast milk, date it when you freeze it and store it in the back of the freezer, not on the door--that's a warm spot that can prompt thawing every time the door is opened. When the time comes to use it, thaw breast milk in warm water. Don't boil or microwave it; both of those heating methods can destroy valuable immunological components that make breast milk the liquid gold it is. Microwaving can also create uneven "hot spots" that can scald a baby's mouth and throat. Finally, don't add fresh breast milk to already frozen or refrigerated milk for storage, and don't refreeze breast milk once it has been defrosted. If you can't use it up, throw it out.

There are several types of breast pumps available--large, hospital-grade pumps, midweight personal-use automatic pumps, small, lightweight, easily portable electric, battery-operated, or manual models that work one breast at a time, and hands-free pumps that strap around your waist, so that you can multitask instead of simply sitting through another pumping session. You'll want a pump that's appropriate to your particular situation. Pumping can be time-consuming and just one more thing to do, but it shouldn't be painful or frustrating. Choosing the right pump can make the difference in breast-feeding success. A baby's natural sucking rhythm is 40 to 60 cycles per minute (one pull per second or a little less). Hospital-grade and personal-use automatic pumps typically operate at 30 to 50 cycles per minute. Other pumps are usually less efficient. As a general rule, the more suction and releases per minute a pump provides, the better it will be at stimulating your milk supply. Consider this: Breast milk naturally changes during each feeding in conjunction with a baby's swallowing technique and suction. In the beginning of a breast-feeding session, breast milk is thin and watery. In the middle, it gets fattier, becoming whole milk. Toward the end, it's even creamier, Labbok said. The fat is healthful; it contributes to satiety, among other benefits. Ideally, you'll want a pump that mimics a baby's natural sucking action. Efficiency is important if you plan to save a large quantity of milk. If you're returning to work, for example, you'll need to have much more breast milk on hand than if you stay home with your baby or are supplementing breast milk with formula.

Once you find the right pump, you'll need to learn how to position it correctly and adjust the suctioning to get the best results. Don't worry--with the right pump, you'll soon get the hang of it. Pumps require some assembling and disassembling for cleaning. Use the dishwasher or hot soapy water to clean any parts of the pump that touch your breasts or the milk containers. Drain them dry before each use.

Consider renting a hospital-grade breast pump if you're not sure how long you'll need to use a pump or if you know you'll need to pump for only a short time and you plan to be home with your baby. If you expect to use a breast pump regularly, especially if you plan to return to work, buy a top-quality midweight, personal-use, automatic model at the best price you can find. This caliber of pump will help you to get a significant volume of milk in a given time and will be your best bet for maintaining your milk supply. If you plan to use a breast pump only occasionally, a manual pump or a small electric or battery-operated one will probably be all you need.

Because using a breast pump can be tricky, most manufacturers now supply informational brochures with their units. You also can call manufacturers' customer-service lines if you encounter problems with a specific pump. Your pump may have a warranty that allows repair or replacement. Check the terms before you buy because they vary. Keep your receipt or the printout from your baby registry as proof of purchase.

There's a host of information on the Internet about breast-feeding in general and specific guidance on such issues as how to get into a pumping routine after you return to work. The La Leche League, at www.llli.org, is a good place to start. This website offers a mother-to-mother forum, an online community of other mothers to whom you can turn for ideas on how to overcome breast-feeding obstacles, answers to your most-pressing questions, podcasts on breast-feeding and being a parent, and information on monthly meetings with experienced mothers in your community who are accredited by La Leche League International. To find a La Leche League group near you, visit www.lllusa.org/groups.php.

The breast-pump bottles that come with most breast pumps are now made without bisphenol A (BPA), a chemical used to make polycarbonate rigid and shatterproof that has been associated with adverse health effects in children. To play it safe, look for "No BPA" labeling on product packaging.

Plastic bottles made without BPA (non-polycarbonate) are solid and sturdy, and a safer way to store breast milk than plastic milk storage bags, which can become contaminated with bacteria if they get bumped by anything sharp, such as the edge of an ice cube.

These electric powerhouses are about the size of a car battery and can weigh 5 to 11 pounds. Manufactured for users in hospitals and for those who choose to rent, they have sensitive controls that allow you to regulate suction rhythm, intensity, and pressure. Some have a pumping action that's almost identical to a baby's natural sucking, which can help to build and maintain your milk supply. A hospital-grade pump can cut pumping sessions in half--to just 15 minutes with a dual pump, which empties both breasts at once. These are expensive to buy, but you can rent them from hospitals, medical-supply stores, lactation consultants, drugstores, and specialty retail stores. Choose this option if nursing is difficult because your baby has trouble latching on, if you're not sure how much you'll need a breast pump but you want one on hand just in case, if you plan to pump for three months or less from home, or if you must dramatically increase your milk supply and need the power of a hospital-grade pump.

Usually no bigger than a briefcase and weighing around 8 pounds or less, these electric breast pumps typically are lighter and slightly less efficient than the hospital-grade models. Like a hospital-grade pump, a personal-use automatic can slash pumping time because it has a powerful motor and serious suction. Many personal-use automatic pumps have suction that mimics a baby's natural sucking, which typically begins with rapid, high-frequency suction and changes to a slower, suck/swallow pattern. This mimicking fosters faster milk flow, although some pumps use a constant vacuum, with self-adjusting suction settings. Intermittent action better imitates a baby than a constant vacuum--and it's probably easier on you, too.

Many models come housed in a black microfiber shoulder (a.k.a. "Metro") bag or backpack, which is ideal if you're working outside your home. They're often equipped with an adapter for your car's cigarette lighter or a battery pack for times when you're not near an electrical outlet. They may come with all necessary attachments, including removable cooler carrier and cooling element, battery pack, AC adapter, and collection containers, lids, and stands. Choose this option if you'll be returning to work full- or part-time and you need to pump throughout the day to maintain your milk supply and express milk for missed feedings.

Using widely available AA or C batteries or household current, these lightweight, compact devices can fit discreetly into your purse or briefcase. They're relatively quiet, but the suction can be sluggish, although the vacuum on some models can be regulated for maximum comfort. Others, though, have a constant vacuum that can cause nipple discomfort. Choose this option if you need to pump only occasionally because you'll be away from your baby now and then--for a night out or for a couple of hours during the day.

With these small pumps, you produce the suction yourself by squeezing a bulb or lever or by manipulating a syringe-style cylinder. There are many designs of manual pumps on the market. Cylinder, or piston-style, pumps usually allow you to control pressure and minimize discomfort. Some manual models can be operated with one hand. They're easier to use than those requiring one hand to hold, one to pump. Choose this option if you're a stay-at-home or work-from-home mom and you need to miss only a rare feeding because of a night out; if you're traveling, or you have plugged milk ducts or sore nipples. A manual pump is also ideal for pumping on the go, in places where electricity may not be available. Look for one with an ergonomic handle, not a bulb, though any small pump could tire your hand and arm and cause repetitive strain injuries if you use it frequently.

Choose this option if your schedule is hectic and you like the idea of being able to do something else while pumping. One such model, Medela's Freestyle, is a rechargeable, double electric pump. The breast shields attach to a nursing bra, the hands-free kit attaches to the top clasps of most nursing bras. (We haven't tested this product.) Note: Many regular breast pumps can be made hands-free with a special pumping bra.

The best pumps mimic a baby's natural nursing rhythm by automatically pumping in two distinct modes: rapid, to simulate a baby's rapid sucking to begin fast milk flow, and slower, to simulate a baby's deeper sucking to produce the most milk flow. Together, the two phases offer a more-authentic breast-feeding experience with greater comfort, increased milk flow, and quicker pumping time. "Closer to nature" brands/models on the market may purport to pump more like a baby. Others allow you to automate the pumping rhythm, speed, and suction at the touch of a button instead of relying on preset controls.

If you'll be using your personal-use breast pump every day, look for a pump that has at least a one-year warranty on the motor. A generous warranty typically is a sign of quality and durability.

If you're pumping on the road or you don't have access to an electrical outlet (for example, you don't have a pumping room at work and you're relegated to a restroom stall), look for a pump that can run on batteries or that includes an adapter that can attach to your car's cigarette lighter. But even if you have a Freestyle hands-free model, we don't recommend pumping while driving because it can be distracting.

If you'll be pumping at work or pumping often, get a double hospital-grade or midweight, personal-use, automatic pump. By expressing both breasts at once, you can complete a pumping session in 10 to 15 minutes. Besides being fast, double pumps are better for milk production. Double-pumping increases levels of prolactin, the hormone responsible for milk production. Smaller pumps or a single pump may not be able to maintain your milk supply long-term and can quickly become frustrating to use.

If you'll be commuting or traveling, a professional-looking pump "briefcase," sporty backpack, or "Metro" shoulder bag is the way to go. Most models, other than the hospital-grade ones, come in a chic, black microfiber case with a shoulder strap. Some models, such as Medela's Pump in Style Advanced, also feature a removable cooling compartment and pump motor, so you can lighten your load by leaving a section at work.

Look for compartments in the pump's carrying case if you'll be pumping on the go and need to store your milk for later. But be sure to keep an ice pack or two with your breast milk in the storage compartment.

Even a 5-pound breast pump can seem heavy after a while if you have to carry it back and forth to work every day along with a briefcase, a purse, and maybe a diaper bag, if you'll be dropping off your child at day care. If you've got a lot to lug and you'll be traveling frequently with your breast pump, get the lightest pump possible within the range of pump you need to buy.

Some breast pumps offer an LCD panel and programmable memory that allow you to record your preferred pumping pattern, so you don't have to reset the pump each time you use it.

To save money (midweight, personal-use automatic pumps can retail for as much as $380), think about renting a pump, which will typically cost about $55 per month, plus, in some cases, a security deposit. But if you plan to breast-feed longer than three or four months, buying is the way to go. Check with your rental vendor. Many offer a price break the longer you rent. For referrals to lactation consultants who can advise you on the type of pump you need and where to rent it, contact the International Lactation Consultant Association (ILCA, www.ilca.org). The hospital where you delivered your baby may have a lactation consultant on staff. Medela, a leading breast-pump manufacturer, also allows you to search by ZIP code or city and state on its website (http://medela.findlocation.com) for retailers that rent breast pumps in your area and local breast-feeding specialists.

You can find deals on new breast pumps online, and at hospital birthing centers. You also can consult a La Leche League leader (www.llli.org) or an ILCA-certified lactation consultant in your area. A little research reveals that there are deals to be had in the online breast-pump marketplace once you know what kind of pump you want. (Not sure where to start? Simply type "breast pump" into a search engine like Google.) A good site for breast-pump deals is www.breastpumpsdirect.com. The site allows you to compare prices, warranties, suction settings, cycle speeds, and other features of competing-brand breast pumps. The site also has a price match guarantee. If you find the same product on another website at a lower price, they'll match that price.

Many hospitals and birthing centers are now in the breast-pump business, offering competitive prices on a variety of pumps, plus advice that can help ensure success. You can also get a recommendation from your hospital's lactation consultant for the right type of pump for you.

We ran across this misguided advice on a popular breast-pumping message board: You don't have to wash a breast pump between sessions. Not having to wash or rinse breast-pump equipment (bottles and shields) during the business day saves time and potentially embarrassing run-ins in the office kitchen or bathroom. Human milk is very effective at killing bacteria for about 12 hours after it leaves the breast, according to one lctation expert, but we don't know what the effect is if it starts drying or is exposed to large amounts of pathogens. If you don't have time to wash breast-pump parts between sessions, place them unwashed in a clean plastic bag, such as a zip-top bag, and store them in the refrigerator. But be sure to wash them thoroughly at least once a day.

It isn't a good idea to use the same personal-use breast pump for more than one baby or to borrow or buy a used pump. But if you must, wash the parts and replace the tubing.

A used pump can put your baby's health at risk because milk and moisture can enter the tubing and bacteria and viruses can grow there. Those potential contaminants can travel through the tubing and lodge in the pump's internal mechanism--the part that connects to the tubing--which can't be removed, replaced, or fully sterilized. That's why manufacturers encourage nursing moms to think of a breast pump as a toothbrush or lipstick--like any personal-use item you wouldn't share with a friend.

But hospital-grade rental pumps are designed for many users and are built to last for years. With these pumps, each mother receives her own milk collection kit to attach to the pump. They're designed so that milk comes in contact only with the collection kit's pieces and not the pump itself, so there's no cross-contamination when the pump is used by more than one mother.

Breast pumps, especially double electric models, are expensive. If you must buy a pre-owned pump or borrow one from a friend (but again--we don't recommended it because it's very risky), wash all the parts you can with soap and water according to manufacturer's directions, and replace the tubing. That advice also applies if you're planning to use the same breast pump you got new for baby No. 1 for later siblings.