INTRODUCTION — A breast pump is a device that allows a woman to express breast milk from the breasts when it is not possible to breastfeed her infant directly. Many women choose to use a breast pump so that they can continue to provide breast milk while working or if their infant is hospitalized. However, it is not necessary for all women who breastfeed to purchase or use a breast pump.
This topic review discusses the use of breast pumps and breast milk storage and preparation .
CHOOSING A PUMP — There are a wide variety and quality of breast pumps available, each of which varies in cost, quality, and efficiency; the optimal pump depends upon the woman's needs and how frequently the pump will be used. No one pump is best for every woman. In most situations, the purchase of a pump should be delayed until after the infant is born; this will allow the woman to determine her and her infant's individual needs.
Some of the most common reasons women use a breast pump include the following: To provide breast milk after returning to work To provide breast milk because the woman is unable to nurse her infant To provide breast milk when the mother needs to go out for a few hours
Multi-user (hospital grade) pump — A multi-user (hospital grade) double electric breast pump is recommended for women with a premature or ill infant and women who cannot nurse their infant. This is the most efficient, easiest, and fastest type of pump, and is the most effective way to maintain an adequate milk supply for an infant's full nutritional needs. The pump should be used within the first two weeks after the infant is born.
Emptying both breasts with a multi-user double breast pump generally takes about 10 to 15 minutes after let-down has occurred. A multi-user pump can be safely used by more than one woman in a hospital and may be rented for home use. Multi-user pumps are large, heavy, and are not intended to be portable. Some commercial health insurance plans cover the cost of purchasing or renting a breast pump.
Single-user (personal) pump — Single-user (personal) electric breast pumps are made for one woman to use several times per day. They are not suited to maintain a woman's milk supply (without intermittent breastfeeding) long term. The life expectancy of single-user pumps is generally about one year, depending upon how frequently the pump is used. Emptying both breasts with a single-user double breast pump generally takes about 10 to 15 minutes after let-down has occurred.
Most of the high quality single-user pumps are self-contained in a carrying case that includes the motor, supplies, and in some cases, a cooler for storing milk. The pump and related equipment are small and light enough to carry on a daily basis and can pump one or both breasts. These pumps work well for the working mother or when traveling. These pumps are intended for use by only one woman; sharing or re-selling of a personal pump is not recommended. Quality single-user pumps are available from Ameda Medela The cost of this type of pump in the United States is approximately $200.
Single-sided pump — If a woman wants to pump occasionally so that she can leave her baby with a caregiver for a few hours, a single-sided breast pump may be adequate. Single pumps are powered by hand, batteries, or electricity. Single breast pumps are not recommended for women who need to maintain their milk supply while working or for a premature infant, but are adequate for occasional use. Pumping both breasts with a single-sided pump takes about 20 to 30 minutes.
HOW TO PUMP — There are a wide variety of breast pumps, each of which has specific instructions for use. The following are general recommendations for use of a breast pump. Wash the hands with soap and water before pumping. It is not necessary to wash the breasts or nipples . Ensure that the pump pieces and milk collection containers are clean. Washing with warm soapy water is sufficient; it is not necessary to sterilize the pump or bottles. Do not wash the pump tubing because it cannot be dried easily. If moisture or milk is noted in the tubing, contact the manufacturer. It may be necessary to purchase new tubing. Most women prefer to sit while pumping. For electric pumps, set the pump's suction strength to a comfortable level. Pumping should not hurt, even for women with sore or painful nipples. The pump's cycling speed (the number of suction cycles per minute) can be set based on personal preference; some women start with a rapid cycle speed then slow the speed after their milk lets down . Be sure that the flanges (the cone-shaped pieces that fit over the breast and nipples) are the appropriate size. When pumping, the nipples should not rub against the tunnels of the flanges. It may be necessary to purchase larger flanges to pump comfortably and to stimulate the breasts correctly. Be sure to purchase pump parts that are the same brand as that of the pump. Parts should not be interchanged from different manufacturers.
Let-down — Let-down is the term used to describe what happens in the breasts when milk is released from the milk glands to the lactiferous sinuses . Let-down is controlled by two hormones, oxytocin and prolactin. Let-down usually occurs within the first minute or two of nursing or pumping. Some women feel a sense of heaviness or tingling in the breasts during let-down while other women cannot feel let-down at all.
Some women have difficulty with let-down while pumping. In this situation, only drops of milk are seen rather than streams of milk flowing from the nipples. Tips to promote let-down include: Gently massage the breasts before pumping Apply a warm wet cloth to the breasts before pumping Pump in a quiet, darkened room to avoid distractions Look at a picture of the baby or smell the baby's blanket
Pumping at work — Women who work and want to provide breast milk usually need to pump two to three times over eight hours, usually for 10 to 15 minutes with a double electric pump. It can be challenging to find the time and space to pump, especially for women who do not have a private office.
Women should discuss their need for a private space with their employer prior to returning to work. While a bathroom is one option, this is not ideal for pumping. It may be helpful to speak with co-workers who have returned to work and pumped to determine if a private space is available. Some employers offer a "pump room" or other private area.
The United States Center for Disease Control and Prevention has published a number of articles that address the need for support of breastfeeding women who work, citing the health as well as economic benefits of breastfeeding.
Pumping for a premature or ill infant — Women who are pumping for a premature or ill infant are often separated from their child because the child is hospitalized. The benefits of breast milk for premature infants include improved gastrointestinal function and protection from common gastrointestinal and respiratory infections. To maintain a supply of milk when it is not possible to breastfeed, most women need to pump approximately eight to 10 times per day. This usually involves pumping every two to three hours, with one extended period of about six hours (often at night). Women who get up to use the bathroom or begin to feel breast fullness are encouraged to pump at that time as needed.
If a woman is not consistently pumping eight to 10 times in 24 hours, especially during the first two to three weeks of the infant's life, she may not establish an adequate milk supply. Pumping frequently during this time increases the chance that the woman will be able to provide a sufficient amount of milk for the infant's needs over time. By day 10 after delivery, most women who are pumping eight to 10 times per day should be producing approximately 750 to 800 mL (about 25 ounces or 3 cups) of milk per day. However, milk volume varies and can range from 450 to 1200 mL (about 2 to 5 cups) per day.
Women who are pumping less than 450 mL (15 ounces) per day by the 10th day should discuss ways to improve their milk supply with a healthcare provider or lactation consultant (see "Finding a lactation consultant" below). After the initial two to three weeks, some women are able to decrease their pumping to six to eight times per day without jeopardizing the milk supply.
STORING PUMPED MILK — Storage recommendations for breast milk are based upon a small number of studies that have examined the safety and nutritional value of breast milk that is stored under a variety of conditions. These recommendations apply to breast milk intended for full term healthy infants. Women with premature infants should discuss breastmilk storage recommendations with their healthcare provider.
Breast milk that is pumped may be safely stored in the refrigerator or freezer. It can even be left at room temperature (approximately 77º F or 25º C) for up to four hours . This is in contrast to infant formula prepared from powder, which should not be left at room temperature after it is prepared.
Refrigerator storage — Freshly pumped breast milk can be safely stored in a standard refrigerator that maintains the temperature at 32 to 29º F (0 to 4º C) for up to eight days . The coldest part of the refrigerator is preferred, generally towards the back and away from the door. Milk can be stored in an insulated cooler with freezer packs (kept at approximately 60º F or 15º C) for up to 24 hours.
Milk should be stored in a sealed, clean, glass or rigid plastic bottle, or polyethylene bag designed for storing breast milk. Milk should be stored in small amounts (one to four ounces) and labeled with the date it was pumped. Milk from different days or pumping sessions may be combined; the milk should be cooled in the refrigerator before it is combined. The label should indicate the date the oldest milk was pumped. The oldest milk should be used first.
Freezer storage — Freshly pumped or refrigerated breast milk can be stored in a freezer that maintains the temperature at 0 to 6º F (-14 to 18º C) for three to six months. The freezer in a mini-refrigerator does not adequately maintain this temperature range and is not recommended. Pumped milk can be stored in a deep freezer chest (0º F or -18º C or less) for six to 12 months. The coldest part of the freezer is best, generally towards the back and away from the door.
Thawed breast milk can be safely stored in a standard refrigerator for up to 24 hours. Milk that was frozen and then thawed should not be refrozen.
Before freezing, milk should be placed in a sealed, clean, glass or rigid plastic bottle, or polyethylene bag designed for storing breast milk. Milk should be stored in small amounts (one to four ounces) and labeled with the date it was pumped. Milk from different days or pumping sessions may be combined; the milk should be cooled in the refrigerator before it is combined. Milk that is warm or refrigerated should not be added to frozen milk. The milk should be labeled with the date the oldest milk was pumped. The oldest milk should be used first.
If milk smells or tastes spoiled — Breast milk that tastes or smells spoiled should not be given to an infant. Some women's pumped milk tastes and smells spoiled (or soapy, in some cases) within hours to days after it is pumped, even if it is stored at an appropriate temperature. A possible cause of this is a higher than normal level of an enzyme, lipase, in the breast milk. Lipase has benefits, although high levels of lipase break down the fat in breast milk, causing it to quickly taste spoiled. It is not known why some women's milk contains a high level of lipase while others do not.
If a woman notices that her milk smells or tastes spoiled quickly, the breast milk may be heated immediately after it is pumped to inactivate the lipase. Milk should be heated to 180º F (32º C) , but should not be boiled. The milk should then be quickly cooled in a refrigerator or freezer. It is not possible to reverse the enzyme's activity in breast milk after it has been stored, thus milk that smells or tastes bad should be discarded.
Heating milk destroys some of its beneficial qualities; mothers of sick or premature infants should discuss the best way to store milk with their healthcare provider.
HEATING PUMPED MILK — Pumped breast milk that is stored in the refrigerator or freezer should be reheated prior to feeding the infant. Breast milk may be heated in a variety of ways. However, it should not be reheated or defrosted in a microwave because microwaves can heat milk unevenly, potentially burning an infant's mouth. In addition, microwave energy destroys some of the beneficial properties of breast milk .
To safely heat refrigerated or frozen milk, a sealed container of milk can be placed in a bowl or cup of warm water until the milk reaches the desired temperature. Bottle-warming devices are also available for purchase; these should be used with care as they can quickly overheat the milk. Do not leave a bottle warmer unattended.
After warming the milk, the temperature should be tested immediately before it is given to an infant; the milk should feel lukewarm or room temperature, but never hot. Milk should be gently swirled to redistribute the cream that often rises to the top during refrigeration.
There are insufficient data to know if it is safe to refrigerate and then rewarm a partially finished bottle of breast milk. Although freshly pumped breast milk has antibacterial properties, milk stored in a refrigerator for more than a day or two begins to lose this property . Milk that smells or tastes bad should not be given to an infant .
HOW MUCH MILK SHOULD I OFFER? — Many women who exclusively pump or pump while at work wonder how much breast milk their infant will need at each feeding.
The volume of breast milk needed increases with the age of a healthy infant who is exclusively breastfed from 23 to 24 ounces at one month of age to 24 to 30 ounces at six months of age. After six months, most infants begin to consume other foods, and less milk may be needed .
One way to determine how much an infant will need per feeding is to divide the infant's average intake (eg, 25 ounces) by the number of feedings per day . For example, an infant who nurses eight times per day would need approximately 3 ounces per feeding (25 ounces divided by 8 feedings = 3 ounces). Thus, for this infant, it would be reasonable to offer 3 ounces of milk per feeding, with the understanding that some infants will consume less while others will want more.
Feeding breast milk with a bottle — Babies feed very differently from a bottle compared to from the breast. Milk flow from a bottle is fast and the baby usually eats very quickly, sometimes by gulping. Many mothers feel that their infant drinks more milk when he or she is fed with a bottle than when nursed at the breast. It is common to worry that efforts to pump enough milk will be inadequate to keep up with this volume.
Babies have little control over milk flow from a bottle while they have full control over milk flow from the breast. To minimize this problem, it may help to pace the baby while bottle feeding by taking frequent breaks. Slow flow bottle nipples are available and may help to minimize the differences in flow between bottle and breast feeding. A feeding should take 10 to 15 minutes or more, just like at the breast.
Some of the most common reasons women use a breast pump include the following: To provide breast milk after returning to work To provide breast milk because the woman is unable to nurse her infant To provide breast milk when the mother needs to go out for a few hours
Multi-user (hospital grade) pump — A multi-user (hospital grade) double electric breast pump is recommended for women with a premature or ill infant and women who cannot nurse their infant. This is the most efficient, easiest, and fastest type of pump, and is the most effective way to maintain an adequate milk supply for an infant's full nutritional needs. The pump should be used within the first two weeks after the infant is born.
Emptying both breasts with a multi-user double breast pump generally takes about 10 to 15 minutes after let-down has occurred. A multi-user pump can be safely used by more than one woman in a hospital and may be rented for home use. Multi-user pumps are large, heavy, and are not intended to be portable. Some commercial health insurance plans cover the cost of purchasing or renting a breast pump.
Single-user (personal) pump — Single-user (personal) electric breast pumps are made for one woman to use several times per day. They are not suited to maintain a woman's milk supply (without intermittent breastfeeding) long term. The life expectancy of single-user pumps is generally about one year, depending upon how frequently the pump is used. Emptying both breasts with a single-user double breast pump generally takes about 10 to 15 minutes after let-down has occurred.
Most of the high quality single-user pumps are self-contained in a carrying case that includes the motor, supplies, and in some cases, a cooler for storing milk. The pump and related equipment are small and light enough to carry on a daily basis and can pump one or both breasts. These pumps work well for the working mother or when traveling. These pumps are intended for use by only one woman; sharing or re-selling of a personal pump is not recommended. Quality single-user pumps are available from Ameda Medela The cost of this type of pump in the United States is approximately $200.
Single-sided pump — If a woman wants to pump occasionally so that she can leave her baby with a caregiver for a few hours, a single-sided breast pump may be adequate. Single pumps are powered by hand, batteries, or electricity. Single breast pumps are not recommended for women who need to maintain their milk supply while working or for a premature infant, but are adequate for occasional use. Pumping both breasts with a single-sided pump takes about 20 to 30 minutes.
HOW TO PUMP — There are a wide variety of breast pumps, each of which has specific instructions for use. The following are general recommendations for use of a breast pump. Wash the hands with soap and water before pumping. It is not necessary to wash the breasts or nipples . Ensure that the pump pieces and milk collection containers are clean. Washing with warm soapy water is sufficient; it is not necessary to sterilize the pump or bottles. Do not wash the pump tubing because it cannot be dried easily. If moisture or milk is noted in the tubing, contact the manufacturer. It may be necessary to purchase new tubing. Most women prefer to sit while pumping. For electric pumps, set the pump's suction strength to a comfortable level. Pumping should not hurt, even for women with sore or painful nipples. The pump's cycling speed (the number of suction cycles per minute) can be set based on personal preference; some women start with a rapid cycle speed then slow the speed after their milk lets down . Be sure that the flanges (the cone-shaped pieces that fit over the breast and nipples) are the appropriate size. When pumping, the nipples should not rub against the tunnels of the flanges. It may be necessary to purchase larger flanges to pump comfortably and to stimulate the breasts correctly. Be sure to purchase pump parts that are the same brand as that of the pump. Parts should not be interchanged from different manufacturers.
Let-down — Let-down is the term used to describe what happens in the breasts when milk is released from the milk glands to the lactiferous sinuses . Let-down is controlled by two hormones, oxytocin and prolactin. Let-down usually occurs within the first minute or two of nursing or pumping. Some women feel a sense of heaviness or tingling in the breasts during let-down while other women cannot feel let-down at all.
Some women have difficulty with let-down while pumping. In this situation, only drops of milk are seen rather than streams of milk flowing from the nipples. Tips to promote let-down include: Gently massage the breasts before pumping Apply a warm wet cloth to the breasts before pumping Pump in a quiet, darkened room to avoid distractions Look at a picture of the baby or smell the baby's blanket
Pumping at work — Women who work and want to provide breast milk usually need to pump two to three times over eight hours, usually for 10 to 15 minutes with a double electric pump. It can be challenging to find the time and space to pump, especially for women who do not have a private office.
Women should discuss their need for a private space with their employer prior to returning to work. While a bathroom is one option, this is not ideal for pumping. It may be helpful to speak with co-workers who have returned to work and pumped to determine if a private space is available. Some employers offer a "pump room" or other private area.
The United States Center for Disease Control and Prevention has published a number of articles that address the need for support of breastfeeding women who work, citing the health as well as economic benefits of breastfeeding.
Pumping for a premature or ill infant — Women who are pumping for a premature or ill infant are often separated from their child because the child is hospitalized. The benefits of breast milk for premature infants include improved gastrointestinal function and protection from common gastrointestinal and respiratory infections. To maintain a supply of milk when it is not possible to breastfeed, most women need to pump approximately eight to 10 times per day. This usually involves pumping every two to three hours, with one extended period of about six hours (often at night). Women who get up to use the bathroom or begin to feel breast fullness are encouraged to pump at that time as needed.
If a woman is not consistently pumping eight to 10 times in 24 hours, especially during the first two to three weeks of the infant's life, she may not establish an adequate milk supply. Pumping frequently during this time increases the chance that the woman will be able to provide a sufficient amount of milk for the infant's needs over time. By day 10 after delivery, most women who are pumping eight to 10 times per day should be producing approximately 750 to 800 mL (about 25 ounces or 3 cups) of milk per day. However, milk volume varies and can range from 450 to 1200 mL (about 2 to 5 cups) per day.
Women who are pumping less than 450 mL (15 ounces) per day by the 10th day should discuss ways to improve their milk supply with a healthcare provider or lactation consultant (see "Finding a lactation consultant" below). After the initial two to three weeks, some women are able to decrease their pumping to six to eight times per day without jeopardizing the milk supply.
STORING PUMPED MILK — Storage recommendations for breast milk are based upon a small number of studies that have examined the safety and nutritional value of breast milk that is stored under a variety of conditions. These recommendations apply to breast milk intended for full term healthy infants. Women with premature infants should discuss breastmilk storage recommendations with their healthcare provider.
Breast milk that is pumped may be safely stored in the refrigerator or freezer. It can even be left at room temperature (approximately 77º F or 25º C) for up to four hours . This is in contrast to infant formula prepared from powder, which should not be left at room temperature after it is prepared.
Refrigerator storage — Freshly pumped breast milk can be safely stored in a standard refrigerator that maintains the temperature at 32 to 29º F (0 to 4º C) for up to eight days . The coldest part of the refrigerator is preferred, generally towards the back and away from the door. Milk can be stored in an insulated cooler with freezer packs (kept at approximately 60º F or 15º C) for up to 24 hours.
Milk should be stored in a sealed, clean, glass or rigid plastic bottle, or polyethylene bag designed for storing breast milk. Milk should be stored in small amounts (one to four ounces) and labeled with the date it was pumped. Milk from different days or pumping sessions may be combined; the milk should be cooled in the refrigerator before it is combined. The label should indicate the date the oldest milk was pumped. The oldest milk should be used first.
Freezer storage — Freshly pumped or refrigerated breast milk can be stored in a freezer that maintains the temperature at 0 to 6º F (-14 to 18º C) for three to six months. The freezer in a mini-refrigerator does not adequately maintain this temperature range and is not recommended. Pumped milk can be stored in a deep freezer chest (0º F or -18º C or less) for six to 12 months. The coldest part of the freezer is best, generally towards the back and away from the door.
Thawed breast milk can be safely stored in a standard refrigerator for up to 24 hours. Milk that was frozen and then thawed should not be refrozen.
Before freezing, milk should be placed in a sealed, clean, glass or rigid plastic bottle, or polyethylene bag designed for storing breast milk. Milk should be stored in small amounts (one to four ounces) and labeled with the date it was pumped. Milk from different days or pumping sessions may be combined; the milk should be cooled in the refrigerator before it is combined. Milk that is warm or refrigerated should not be added to frozen milk. The milk should be labeled with the date the oldest milk was pumped. The oldest milk should be used first.
If milk smells or tastes spoiled — Breast milk that tastes or smells spoiled should not be given to an infant. Some women's pumped milk tastes and smells spoiled (or soapy, in some cases) within hours to days after it is pumped, even if it is stored at an appropriate temperature. A possible cause of this is a higher than normal level of an enzyme, lipase, in the breast milk. Lipase has benefits, although high levels of lipase break down the fat in breast milk, causing it to quickly taste spoiled. It is not known why some women's milk contains a high level of lipase while others do not.
If a woman notices that her milk smells or tastes spoiled quickly, the breast milk may be heated immediately after it is pumped to inactivate the lipase. Milk should be heated to 180º F (32º C) , but should not be boiled. The milk should then be quickly cooled in a refrigerator or freezer. It is not possible to reverse the enzyme's activity in breast milk after it has been stored, thus milk that smells or tastes bad should be discarded.
Heating milk destroys some of its beneficial qualities; mothers of sick or premature infants should discuss the best way to store milk with their healthcare provider.
HEATING PUMPED MILK — Pumped breast milk that is stored in the refrigerator or freezer should be reheated prior to feeding the infant. Breast milk may be heated in a variety of ways. However, it should not be reheated or defrosted in a microwave because microwaves can heat milk unevenly, potentially burning an infant's mouth. In addition, microwave energy destroys some of the beneficial properties of breast milk .
To safely heat refrigerated or frozen milk, a sealed container of milk can be placed in a bowl or cup of warm water until the milk reaches the desired temperature. Bottle-warming devices are also available for purchase; these should be used with care as they can quickly overheat the milk. Do not leave a bottle warmer unattended.
After warming the milk, the temperature should be tested immediately before it is given to an infant; the milk should feel lukewarm or room temperature, but never hot. Milk should be gently swirled to redistribute the cream that often rises to the top during refrigeration.
There are insufficient data to know if it is safe to refrigerate and then rewarm a partially finished bottle of breast milk. Although freshly pumped breast milk has antibacterial properties, milk stored in a refrigerator for more than a day or two begins to lose this property . Milk that smells or tastes bad should not be given to an infant .
HOW MUCH MILK SHOULD I OFFER? — Many women who exclusively pump or pump while at work wonder how much breast milk their infant will need at each feeding.
The volume of breast milk needed increases with the age of a healthy infant who is exclusively breastfed from 23 to 24 ounces at one month of age to 24 to 30 ounces at six months of age. After six months, most infants begin to consume other foods, and less milk may be needed .
One way to determine how much an infant will need per feeding is to divide the infant's average intake (eg, 25 ounces) by the number of feedings per day . For example, an infant who nurses eight times per day would need approximately 3 ounces per feeding (25 ounces divided by 8 feedings = 3 ounces). Thus, for this infant, it would be reasonable to offer 3 ounces of milk per feeding, with the understanding that some infants will consume less while others will want more.
Feeding breast milk with a bottle — Babies feed very differently from a bottle compared to from the breast. Milk flow from a bottle is fast and the baby usually eats very quickly, sometimes by gulping. Many mothers feel that their infant drinks more milk when he or she is fed with a bottle than when nursed at the breast. It is common to worry that efforts to pump enough milk will be inadequate to keep up with this volume.
Babies have little control over milk flow from a bottle while they have full control over milk flow from the breast. To minimize this problem, it may help to pace the baby while bottle feeding by taking frequent breaks. Slow flow bottle nipples are available and may help to minimize the differences in flow between bottle and breast feeding. A feeding should take 10 to 15 minutes or more, just like at the breast.
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