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misc.kids FAQ on breastpumps, Part 1/2

( Part1 - Part2 )
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Archive-name: misc-kids/breastfeeding/breastpumps/part1
Posting-Frequency: monthly
Last-modified: 1995/03/01

See reader questions & answers on this topic! - Help others by sharing your knowledge
                    Misc.kids Frequently Asked Questions
                              Breastpumps

=====================================================================
Collection maintained by: Beth Weiss   bweiss@cs.arizona.edu
Last updated: 1 March 1995

To contribute to this collection, please send e-mail to the address
given above, and ask me to add your comments to the FAQ file on
breastpumps.  Please try to be as concise as possible, as these FAQ
files tend to be quite long as it is.

For a list of other FAQ topics and how to get the archived discussions,
tune in to misc.kids or misc.kids.info.
=====
Copyright 1994, Beth Weiss.  Use and copying of this information are
permitted as long as (1) no fees or compensation are charged for
use, copies or access to this information, and (2) this copyright
notice is included intact.
====
############################################################
This FAQ file contains several parts, separated by lines of ## signs.
  When posted, parts I-V are in part 1
               part  VI  is in part 2

I.  Logistics
      A.  Summary of replies about the logistics of pumping
      B.  How long can I store the milk
II. How to encourage a let-down
III.General pump-buying and getting started advice
IV. Encouraging success
      A.  General advice
      B.  Survey of Successes
      C.  Nipple confusion survey
V.   Supplies
      A.  Carriers
      B.  Suppliers
VI.  Which pump should I buy?
      A.  Manual options
      	  ** by hand
          ** Medela manual
          ** Sears
          ** Kaneson
      B.  Battery operated pumps
          ** Evenflo
          ** Mag Mag
          ** Gentle Expressions
      C.  Small electric pumps
          ** Medela mini-electric
      D.  Fish tank pumps
          ** Nurture III
          ** Gerber Precious Care
          ** Double Up
      E.  Rental pumps
          ** Ameda Egnell
          ** Medela Lactina
          ** Medela (classic)

############################################################
I-A.  Logistics
----------------
I requested information about the logistics of pumping milk,
especially for a daycare situation.  Here's a summary of responses.

Storage
-------
   There are at least four methods that people mentioned: disposable
bottles, ziploc-type bags, actual bottles, ice cube trays.

   Disposable bottles
   ------------------
   These can be purchased in most grocery, drug, kid stores.  Playtex
has 4 ounce sizes.  Playtex, evenflo and store brand have 8 oz sizes.
Don't put too much milk in a bag (2-3 oz in a 4 oz bag), since it will
expand when freezing.  Most people close the bags with twistie ties;
some use tape.  Label the bags with the amount in them and the date.

   Misc. points people made:
      Evenflo bags have the amounts on the bags--easier to mark.  The
         newer Playtex bags also do.
      Store milk in small amounts to eliminate/limit wasted milk
      Store bags hanging until they're frozen (clip to the side of a
         tupperware container).  This works especially well with
         bags that are taped closed.
      If you're pumping every day for the next day, there's no need
         to freeze the milk.  Just store it in bottles for the next
         next day
      Some people double bag, others say it isn't necessary, because
         they've had very little breakage/leakage
      Store different amounts (1 oz, 2 oz, 2.5 oz, etc.) so that
         bottles of the appropriate size can be made by combining
	 bags
      There are also bags that can be purchased especially for storing 
         breastmilk.  Both Medela and Emeda Egnell sell them.

Note: Nursing Mother's Counsel does not recommend using Evenflo or
Plaxtex bags for either the storage or storing of breastmilk.  The
bags are permeable to bacteria and are not thick enough to prevent
freezer burn.  Certain factors in breastmilk adhere to the plastic
bags.  Medela makes storage bags that do not have these problems.
   
Bottles
-------
   Buy lots of cheap plastic bottles, and store directly in the
bottles.  To use, just defrost in warm water, and add nipple.

Bags vs. Bottles
----------------
      Bags take less freezer space than bottles
      Bags defrost quicker than bottles
      Don't need to transfer as many times with bottles

Ice cube trays
--------------
   Apparently, each cube holds about an ounce, and the daycare
provider just defrosts as many as are needed.   There may be concerns
with milk contamination or freezer burn with this method.

Nipples
-------
   Just about everyone recommended silicon orthopedic type nipples.
Several people suggested that a trial-and-error period might be
necessary to find which kind of nipple the baby would take.

Transporting the Milk
---------------------
   Some people bough special "milk transport bags".  Some used
insulated bags.  For short distances, it probably doesn't matter.

Using the Milk
--------------
   Bags can easily be defrosted by running them under hot water.  They
thaw quickly.  Some people then transfer the milk to a plastic bottle.
Others use the Playtex nurser system, and just insert the bag into the
nurser.  (Try this with a bag full of water before risking milk).
Some people have heard that breast milk should be defrosted by running
under cold water.

Warning: don't microwave breastmilk.

Some people prepared the bottles at home, others let the daycare
provider make them.  Some people take all of the dirty bottles/nipples
home and sterilize them, others have the daycare provider do it.

Nursing Mothers' Counsel recommends defrosting milk by moving it to
the refrigerator 8 - 12 hours before it will be used.  Heat and
vigorous shaking can damage milk cells.  Milk should be defrosted with
water no warmer than body temperature and gently swirled to mix the
cream.

When to Start
-------------
Try and build up a backlog of milk in the freezer.  Most women don't
pump enough during the workday to totally feed the baby, so you will
need the backlog.  Give the first bottle at 3-4 weeks, if you're going
back to work at 6 weeks, so you have time to discover what kind of
nipples the baby likes.  (See the Nipple Confusion Survey later in
this file.)

============================================================
I-B. Storage Information
------------------------
Milk will keep for 6 hours at room temperature, 48 hours
in the fridge, two weeks in a little top-of-the-fridge freezer,
and six months in a big deep freeze. Date each package and
use the oldest first.

You prorate exposure: that is, if the milk was at room temperature
for two hours coming home, it has used 1/3 of it's life and can
only have 32 hours in the fridge now.

Adding More Milk to Already Frozen Milk
---------------------------------------
Also, you can "top up" a bottle of frozen milk under the followng
circumstances: you must have more in the bottle than you
are adding, (eg adding 1/2 ounce to 4 ounces) and you must
add it cold -- chill it in the fridge first.  For example, you can
keep a bottle going in the freezer: pump an ounce or two and use
1/2 ounce or so at a time to use to make  up rice cereal. 
Whatever isn't used put in the fridge for an hour or so
and then add to the bottle in the freezer. 

BTW, I was always told to defrost it under COLD running water,
then warm it up with hot.
############################################################
II. How to encourage a let-down
-------------------------------
This is a summary of suggestions for encouraging a letdown when
pumping:

** Relax (take several deep breaths and, if you know any relaxation,or
meditation techniques, use them.  Prop up a picture of your baby in
front of you and stroke your breast, toward the nipple.  Sounds silly,
I know, but it works.  (The relaxation is the big part, the rest is
probably just dressing)

** Look at a picture of your child, think about the child actually
nursing and the milk began to flow.  In fact I was pumping enough milk
for her for the next day and even had some to freeze.

** Bring in a picture of a child and a cassette recording of her
crying and such.  When you are having a hard time letting down, look
at the picture, play the tape, and think about your child.

** Call your doctor.  There is a synthetic hormone that he/she can
prescribe for you called Oxytosin (sp?) which will IMMEDIATELY cause
the let down reflex.  This hormone is administered by nasal drops and
works great!  It runs about $40 a bottle but if your insurance will
cover it - go for it!  (Warning: these can be habit forming, and
increased dosages might be needed for continued effectiveness, so use
with care.)

** If your baby smells a particular way sometimes you can use that to
trigger let down too (like baby powder or something; my first always
smelled a bit like the infant sheepskin he slept on, and that always
triggered let down for me).

** It is REALLY hard to get the let down reflex at work especially if,
like me, you have to pump in the restroom - frustrating!  If there is
a private office with a door that locks (so you can relax and not
worry about "company" dropping in) use it!

** Nipple stimulation (twirling them between my finger and thumb)
until the letdown came. Or, if you have a one handed pump like the
Avent manual model, do the nipple stimulation on one side while you
pump the other. It may take several minutes at first but with practice
the response gets faster.

** pump at regular times (every day or every work-day).  Whenever I
take week vacations or somesuch, I have a harder time when I return to
regular pumping.

** be sure to sit in a comfortable chair

** warmth.  It's always easy for me to pump after a warm shower (it's
hard to stop from leaking, sometimes!).  If not available (e.g. at
work), try warm washcloths on the breasts.

** I eventually learned that if I pushed along the sides of my breasts
I could sort of make the milk squirt out and was eventually able to
get 3 oz or so most times after about 15-20 min of work.

** My suggestion to you would be to rent the Medela electric pump for
awhile.  use it at work, if you can, or at least at home so that you
can get the feel for it.

** I found that I had to use visualization techniques to let down.
Early, for the first 2-3 months of pumping, I could just visualize my
son when he was a very young baby with his little mouth working away.
As he got bigger, I had to guilt trip myself. I would visualize the
alternative - him drinking formula from a bottle and that would lead
to very large collections - I hate the smell of formula.
############################################################
III. General pump-buying and getting started advice
---------------------------------------------------
Things to look for [when choosing a pump]:
-- how easy will it be to clean?
-- how comfortable or awkward would it be to use it?
-- how noisy is it? (may not matter to you)
Some breast pumps attach directly to bottles, and this may be an
advantage if it works with the bottle system you've chosen.  I don't
think that's all that important, though.

If you're planning to do any breast-pumping at work, you might want to
scout two things out in advance:  a restroom or other quiet spot with a
comfortable place to sit, and a refrigerator if you're going to keep the
milk and take it home.  Also expect to have some funny stories about how
people react!
------------------------------------------------------------------------
Do you think it would be possible to put in a plea to women not
to use a pump if it hurts?  Anytime you feel pain during nursing
or pumping, there is some possibility of tissue damage.  Nipples
should be treated gently at all times.  If a pump hurts, stop
using it or turn down the suction.

I've seen too many women lose their milk supplies using inadequate
pumps and I've seen some brutally damaged nipples from pumps that
don't have an automatic release cycle.
------------------------------------------------------------------------
I believe that the important factor in comfort in using a breastpump
is the steadiness with with the force of the suction is increased. A
jerky increase in suction is more uncomfortable than a smooth one.
Sensitivity in women's nipples varies dramatically. Some don't mind
even the least smooth-operating breastpump, others find even the
smoothest somewhat uncomfortable and the others unbearably painful.
------------------------------------------------------------
One of the most important points in using a pump is getting a good
let-down first. This reduces discomfort and increases yield
dramatically.  Stimulation of the nipples is one way to achieve this.
------------------------------------------------------------
Hint (which will make more sense once you are already nursing): To get
the most milk as quickly as possible when pumping, ensure you have a
let-down. This may mean thinking about your baby nursing or it may
mean direct nipple stimulation (the latter for me). It makes pumping
very much easier and faster. In addition, if you massage the breast
while pumping (sort of "pushing" the milk towards the nipple and
squeezing gently), you'll get a better yield.
------------------------------------------------------------
I have one question to the more experienced pumpers.  Is it common to 
have three or four letdowns in a pumping session?  Until I realized that
there was a lot more coming, I would stop much too soon.
------------------------------------------------------------
I never got much milk from pumping, even with the Medela. I know woman
that could get more milk hand pumping then I could with the Madela. I
didnt have a very easy let down reflex. On the plus side, I didnt need
to wear breast pads either.

On one hand, I would suggest waiting until after you deliver, to see
what level of pumps you need, but the gerber pump was really great to
have around to help with some early breast feeding problems (inverted
nipples, clogged ducts, an infant that didnt want to suckle at first,
etc).
------------------------------------------------------------
One thing to note is it will go though a lot of cycles, whether
hand-powered or electric, so the mechanism (espacially springs etc)
will have to be robust. The pump we used for the oldest had springs
break regularly: it was supplied with spares, but not enough.

Ease of cleaning/sterilising is also important. The metal bits can't
be chemically sterilised, and electic bits can't be submersed.  I used
three different types of pumps (Magmag, Gerber, and Madela). The all
pumped the milk directly into bottles, and all three used a the
standard bottle thread. You dont need to use the ones they include.
The magmag bottle had a wide rimmed cup, but the lid had a smaller
opening that you attached the pump too. A standard bottle will fit it.

But--if you use a standard bottle that is *larger* than the one
supplied with the pump, i. e. has more cubic volume, more surface area
that the vacuum has to act on, or any slight mis-fit causing vaccuum
leakage between bottle and fitting, you get less suction so it takes
longer to pump.  Medela gets around this problem by those little
thing-a-ma-jigs that pop up and down during the suction cycle.  So it
doesn't matter what size of bottle you use with Medela.  But with the
other cheaper pumps if you are using rechargeable batteries you are
going to get a reduction in suction over what you would have with non-
rechargeable batteries, because the voltage is slightly lower.  I was
always running them with the suction wide open, and couldn't spare any
more loss of suction.  I did notice a difference with bottles that
didn't come with it, so I just washed out the ones that did come with
it and transferred the milk into the playtex nurser type of bottles.
------------------------------------------------------------
If you give birth in a hospital, one thing that might be worth looking
into ahead of time is whether the hospital sells breast pumps.  The
reason that I mention it is that some insurances will cover the cost
of a breast pump along with other medical expenses billed from the
hospital.  The hospital I gave birth at sold a battery powered unit
which turned out to be okay.  Since I got the pump while I was a
patient at the hospital, the charge for my pump was included with
along with the rest of expenses incurred during my hospital stay and
my insurance covered 90% of the cost.  I didn't plan it that way, but
it happened that way and was nice for me to get a pump at a cheap
price.  So that way it's not so bad if the pump doesn't work out.
------------------------------------------------------------
Many professionals (lactation consultants, etc...) will only recommend the
Medela or Ameda Egnel pumps because they are the ONLY ones that regulate
pressure, and test for pressure.  Some other pumps (such as the previously
mentioned MagMag, as well as Gentle Expressions, and the like) can do some
SERIOUS breast tissue damage - and there is really no way to tell if your
breasts are going to be sensitive to a pump until it is too late.
############################################################
IV-A.  Advice on how to pump successfully
-----------------------------------------
The two most frequently mentioned elements for successful pumping
were:

* Using a rented professional pump such as a Medela.
* Finding a comfortable location for pumping (NOT the restroom).

The most common pumping frequency was twice during the workday.  In
several cases, the frequency varied during the pumping months. Also,
some mothers were able to nurse once during the workday, and some were
working half-days.

Of the 16 responses I collected:

        - 11 mentioned using a rented Medela pump
        - 11 pumped twice at work for most of the time
        - 8 mentioned the importance of a good location
        - 6 mentioned that they pumped at home too
        - 5 mentioned supplementing with formula
        - 5 said they never supplemented
        - 4 pumped 3 times at work, at least at first
        - 3 wrote that double-pumping was very useful in
                keeping supply up and pumping time down
        - 2 pumped once a day at work

To avoid making this *too* long, I'll list a few examples of the
advice and experiences:
--------------------------------------------------------- 
"More important, I think, is to have a private room where you can use
a rental pump."

"It's important to have a private and relatively comfortable place to
pump at work and to figure out when the best time of day is for your
milk supply."

"My biggest recommendation is to find a comfortable place to pump."

"To make pumping easier I rent a Medela Lactina pump and keep it in my
office during the week and take it home over the weekend. At home I
have a small Medela pump which runs on either AC or batteries. The
small pump cost about $80.00 and was worth every penny. It included
most of the parts I needed for the rental pump."

"The best thing that you can do is to rent a good pump."

"My best advice is to get a good quality pump!"

"I would also recommend buying a double pump attachment....  When I
used a small battery pump, it would take me about 30 minutes to pump
about 4 ounces.  And, it would hurt most of the time.  With the good
pump (and pumping both breasts at once), I was able to pump 6 ounces
in 10 minutes."

"Double pumping was a lifesaver, though you feel like a cow hooked up
to a milking machine.  It would generally only take me 20 minutes to
get to the pumping station, double pump, wash the stuff and get back
to my desk."

"... (generally) breastfed babies don't drink very much expressed milk
while away from their mothers.  They prefer to "hold out" as much as
possible and nurse when they get back together with mommy."

"BEFORE you return to work... start expressing some of your milk."

"Expressing AND nursing will increase your milk production."

"IMPERATIVE.  Make sure Jr. takes the bottle (of expressed milk, of
course) BEFORE you go to work."

"If you are breastfeeding YOU ARE STILL EATING FOR 2.  DO NOT start
"dieting"...Drink, drink, drink...  and then drink some more!"

"By all means practice with the pump before you head back to the
office."

"Another thing I did to alleviate anxiety was give the sitter a can of
powdered formula to keep an hand for emergencies."

"...the most important advice I can give: STOCKPILE, STOCKPILE,
STOCKPILE!"

"Definitely follow the suggestion of one of the previous replies and
bring extra pads and keep an extra top handy(or use a sweater)."

When I am using a pump, moving the flange from one area to another
helps increase my yield.  Also, vary the amount of pressure placed on
the flange, from light to pressed strongly against your chest wall.
If you are single pumping, try using your other hand to curl your
fingers around the outside edge of your breast and press inward to see
if you can increase the flow.

In my opinion, the issue of supplementing should be looked at in
a broader perspective that incorporates other portions of your life.  I  
could have got enough milk to avoid supplementation by pumping in the
evenings and on weekends.  However, that would cut down on my sleep, time
with my kids, and time to do other urgent tasks, and I didn't deem it
worthwhile.  Some women can produce vast amounts of milk with little
apparent effort, and for them, avoiding supplementation takes almost
nothing extra.  However, for anyone that is struggling unhappily to get
enough to cover their infant's needs, I'd suggest stepping back and 
taking a look at *all* your goals and priorities, and deciding if it
really matters.  If it does, there are lots of things you can try to
increase your supply, the efficiency of your pumping, and the arrangement
of your baby's feedings.  If it doesn't matter, get what you can    
comfortably get in the time you have available, and use formula 
sparingly to fill in the difference.

Women differ a lot, and it is important that first time pumpers know
it.  I've got a friend that can hand express 8oz in 10 minutes every 2
or 3 hours.  On the other hand, I've never got 8oz in a single
session, regardless of the method used, and I've got friends that get
even less than I do.  Don't compare yourself, but if you can, do try
different methods/ techniques to see if you can get more.

Pumping takes practice, patience, and persistance.  Try not to get
discouraged, don't compare amounts with other women, and constantly
look for new techniques.  I tried lots of different pumps, timings for
pumping, and methods.  For example, my current pump can double or
single pump, and I am pretty good at manually expressing.  I try
different combinations of each, both at the same pumping "session",
and at separate sessions.  On average, I usually double pump for about
10-12 minutes, then switch to single pumping when I'm not getting much
anymore.  Single pumping allows me to massage with the other hand
which allows me to get more.  On times when I haven't had a good let
down (and there are a lot of those times...) I might then do some
manual expression at the end, as I find it is the most effective in
getting the milk out.  I've also tried single pumping first, or double
then single then back to double, or alternating a manual expressed
"session" with a pump session, etc.  Different things work different
times, and I'm always finding new little tricks.

============================================================
IV-B.  Survey of Successes
-------------------------
Paula Burch took a survey and compiled these results.  I'm including
in hopes that it will help choose a pump with which other women have
successfully pumped at work.

------------------------------------------------------------
The people who responded to my poll on breastpumps must be wondering
what happened to the results. Sorry, it took a while to analyze.
This is the original poll:

>1. What kind of pump did you use?
>   a. Large Medela (not Lactina, but the heavy cast-metal 
>      in clear acrylic one)
>   b. Medela Lactina
>   c. Nurture III
>   d. inexpensive (<$100) electric pump
>   e. battery-operated pump
>   f. manual pump
>   g. hand expression
>(If these categories don't fit, tell me so.)
>
>2. How long were you able (or have you been able so far) to express
>enough milk to meet your baby' needs without supplementary formula?
>Weeks? Months? Not at all?

There was so much data that came in! 

The hypothesis I was testing was whether women who use inferior pumps
end up supplementing with formula earlier than women who use a better
pump. The reason for the hypothesis is that it seemed to me that those
I spoke to who used the heavy-duty Medela Classic seemed to be able to
do without supplementation longer than the ones I knew who were using
the small, cheap, and to some women, painful ones. Many women seem
surprised when they learn that my friend with the nine-month-old is
still pumping successfully.

I cut out all the answers such as "two months so far", so I could
average the numbers. Two months in this example would skew things
badly if that particular baby ends up without supplementation until 9
months of age!

Answers:  
a. Large Medela................avg 9.5 n=7
b. Medela Lactina..............avg 6.4 n=7
c. Nurture III.................avg 9 n=2**
d. inexpensive electric........avg 6.6 n=7
e. battery operated............avg 6.9 n=11
f. manual......................avg 9.6 n=8
g. hand expression.............avg 7 n=1**
** = not enough to consider significant, even without statistical testing 

Conclusions:

The large Medela and manual pumps are superior to anything else. I
expected the large Medela to win, but not the manual pumps. Are manual
pumps better, or is it only that only women naturally blessed with
high milk production and easy let-down use them? You decide. The
Lactina and smaller electric or battery-operated pumps are not as good
as either.  (Six months looks like a fine average, but there were
plenty in there who had to give up at four weeks!)

Several women strongly agreed that the large Medela (not Lactina) was
essential to their success with pumping. Several other women disagreed
with the whole idea that brand matters. Make what you wish of this!

Other factors that are important in success of pumping, and
some miscellaneous notes: 
(Some of these are much more important than one's choice of pump)

1. The day-care provider's committment to helping you breastfeed.

This is an odd one--it's not harder to use breastmilk than formula,
after all, even easier when you consider there's no mixing or
sterilizing for the day-care provider to do. (Other factors must enter
into unwillingness to support breastfeeding.) No matter how much you
pump at work during the day, it hurts your efforts if you get home
with full breasts, only to be told, "Oh, I just fed him." It's hard to
get as much at a feeding as the efficient baby could get for him or
herself.

2. Trouble with letdown

If you don't get a good letdown, you'll end up with sore nipples and
almost no milk pumped. This may mean tickling your nipples, thinking
lovingly of your baby, or whatever.

Many women can't find anyplace other than the ladies' restroom to
pump. That MUST reduce letdown, I think! Yuck. Employers ought to
provide a decent room, closet, or whatever for this, for those who
don't have offices.

3. How many feedings you have to pump for.

Three times a week is obviously much easier than five. My friend said,
early on, that she got 350 mls from pumping on Monday, but by Friday
that was down to 250 mls. The weekend, with frequent nursing, built
her supply back up every time.

4. Double pumping (both sides at once)

Which is more significant, cutting the time in half so you don't get
bored or have to hurry back to your work, or the increased prolactin
levels Medela claims that research shows? Could be either or both.
You can double-pump with either of the Medelas and the Nurture III,
and some women buy two MagMags so they can use one on each breast.

5. Having someone else pumping along with you.

It's easier to remain committed to something that people around you
think is normal.

6. Time to try pumping two or three times during the day, instead of
only at lunchtime.

Most women can pump only 4 to 6 ounces at a time, judging from my
mail. I've gotten up to eight, but 6 is more usual.

7. If you're on maternity leave (such as it is), going to go back to
work, but haven't gone yet, you should be pumping after feedings and
stockpiling what you get in the freezer. You'll be glad you did! 

8. Gaskets!

If the gaskets get worn, your production will appear to be going
down--call the company to get new ones! (This was on a Nurture III.)

Someone added: I had to make sure I cleaned the gaskets directly with
undiluted dish-detergent.  If I washed them with soapy water or diluted
the detergent in any way, they would not get clean enough.  They would
stick to the bottle and not seal correctly and then I couldn't let down.
I had to put the detergent directly on the gaskets to get them clean
enough for me.

9. Note: costs vary dramatically for the same pump. For example, my
MagMag (which I hated) was $40 in the Right Start catalog. Someone
told me she paid $63.00 at Oh Baby in San Diego.  

10. So how much milk do you get when you pump? The most interesting
part of this posting to anyone who has just started with this
business!
  "I seldom got more then 3-4 ounces at a time."
  "My first son took 15 oz of expressed milk a day, my second, 18 oz."
  "I always got the same 4-6 ounces."
  "I was able to pump 4 oz. at a time when I started, and it was down to
     about 1 oz. at a time when I stopped.  "        
  "I was pumping about 8-14 oz a day towards the end."
  "I've only been successful pumping about 6-9 oz at work. Total daily
     amount: 12 oz. "
  "I was pumping 8 oz a day (4-5 am, 4-5 pm) a day, I am now pumping 6 oz
     a day, and usually freeze the extra 3 oz. [She sees her daughter at
     lunchtime.] "
  "I pumped about 8 ounces worth a day."
  "I usually get about 8-10oz at work."
  "...can only pump 8-10 oz at work."
  "I get up to 8 ounces per meal `skipped'."
	 
11. Far more important than being able to avoid supplementation is
whether your milk dries up due to not getting enough sucking and/or
pumping time in, so you can't nurse even when you're home. Many women
have success with supplementation. Fewer women find that breastfeeding
fails utterly soon after supplementation--fewer, but a sizable minority.
At that point, a two-week vacation might get things back to normal,
but who has vacation time left after being out sick for maternity
leave in a company that doesn't give maternity leave?

"....here's the executive summary of what I would tell someone who
wants to express at work: 

	* get support
	* get educated
	* if it's what you really want, don't give up"

Many thanks to: Marcie, Laura, Beth, Lyssa, Sherri, Sue, Chris, Mimi,
Charlene, Maureen, Debra, Joanne, Saki, Michele, Peggy, Vicki, Audrey,
Suzzanne, Lee, Charlotte, Alice, Anne, Diane, Kami, Betsy, Chris,
Kathleen, Kathie, Suzanne, Misty, Michael, Kate, Mary Jane, Sarah,
Joanne, Donna, Shirl, Anne, Barbara, and others (who didn't want their
colleagues to see their names on something as, um, intimate as this!
:-)
============================================================
IV-C.  Nipple confusion survey
------------------------------------------------------------
The breastfeeding/bottles poll, given in the four questions below, 
was answered for sixty different babies:
|> ----------------------------------------------------------------------
|> 1. My baby first had bottles
|>      a. before three weeks of age
|>      b. between 3 and six weeks of age
|>      c. between six weeks and 3 months of age
|>      d. after 3 months
|> 2. (Before the age of three months) my baby
|>      a. did not have troubles with breastfeeding due to nipple confusion
|>      b. did have troubles with breastfeeding due to nipple confusion
|> 3. (After six weeks of age) my baby
|>      a. refused to take a bottle later on
|>      b. took a bottle without any problem later on
|> 4. (After six weeks of age) my baby
|>      a. did
|>      b. did not
|>    wean him/herself to a bottle without being encouraged to do so.
|> ----------------------------------------------------------------------

Standard advice is to avoid introducing bottles before a baby is 3 weeks
old, to avoid dooming efforts to breastfeed by nipple confusion, but
then to be sure to introduce a bottle before the baby is six weeks old
to ensure that the baby WILL take a bottle when it's important for
him/her to do so. Another issue is that it's often very upsetting for
mothers committed to the benefits of breastfeeding when their babies
decide to forgo the breast altogether in favor of bottles; the question
is whether the time of first bottle introduction has any effect on this.
==========================================================================
Hypothesis 1: bottles introduced too early (usually taken as < 3 weeks
after the baby is born) lead to the trauma of nipple confusion (which
often dooms breastfeeding). 

Results: 33 had bottles in first 3 weeks. Of these, 9 had nipple
confusion, or 27%.  Out of a total of 60 babies, 10 had nipple
confusion, or 17%. Only one respondant of the 27 (or 4%) whose first
bottle experience was after three weeks indicated nipple confusion when
the first bottle was after the first three weeks; that baby had the
first bottle after 6 weeks but before 3 months, took a bottle later, and
self-weaned to a bottle (i.e., gave up the breast without being 
encouraged to do so). 

Conclusion: Bottles introduced too early often do lead to nipple
confusion, and nipple confusion can almost always be prevented by
avoiding bottles in the first three weeks. However, there is a 2/3
chance of avoiding nipple confusion even if you allow bottles to be
introduced tooearly. (I personally do not consider these odds good
enough to allow early bottles, when you consider how horrible the nipple
confusion experience can be.) There will now be some interest in
comparing first-week  bottles to bottles first introduced at two weeks, 
etc.; someone *else* may volunteer to take that poll. :-)
==========================================================================
Hypothesis 2: bottles should be introduced by the age of six weeks to
prevent total rejection of bottles later on, such as when the mother
returns to work.

Of the 14 babies who rejected bottle-feeding, 6 (43%) had their first
bottle  before three weeks, 1 (7%) between 3 & 6 weeks, 3  (21%) between
6 weeks &  3 months, and 4 (29%) after three months. Of the 41 which did
not reject bottle feeding (not counting 5 respondants with non-a, non-b
answers to question 3), 25 (61%) first had  bottles < 3 weeks, 7 (17%)
first had bottles 3-6 weeks, 6 (15%) first had  bottles 6 weeks to 3
months, and 4 (8%) had their first bottles after three  months.
		+ bottles	-bottles
< 3 wks.	43 %		61 %
3-6 wks.	7 		17
6 wks.-3 mos	21		15
>3 mos.		29		8

Conclusion: Babies first given bottles before the age of 6 weeks had a
23% chance of rejecting bottles altogether in favor of the breast;
babies first given bottles after the age of 6 weeks had a 50% chance of
rejecting bottles altogether. Introducing bottles by 6 weeks does help,
but is far from fool-proof.
==========================================================================
Hypothesis 3: Date of bottle introduction affects whether the baby later
rejects the breast altogether in favor of bottles.

13 babies weaned to the bottle (rejecting the breast altogether) without
being encouraged to do so by their mothers. In most but not all cases
this was traumatic for the mother who felt that it was best to continue
breastfeeding. Of these, 6 (46%) had early bottles at < 3 weeks, 1 (8%)
had its first bottle  at 3-6 wks, three (23%) started bottles at 6 wks
to 3 mos, and 3 (23%) first  started bottles after three months.  Of
non-self-weaners, 27 (60%) had <3wks, 7 (16%) 3-6 wks, 6 (13%) 6 wks-3 
mos,  and 5 (11%) > 3 mos.

weaned	breast
46%	60%
8	16
23	13
23	11

Conclusion: the ones who self-weaned to bottles were more likely to have
had first bottles late! This is a surprising result, and, as with the
two questions above, I have run no statistical tests to determine
whether the figures are significant.
==========================================================================
Overall conclusion: Bottles should be introduced after three weeks but
before six weeks. Secondary conclusion: it would be interesting to
fine-tune a poll to see whether three weeks is indeed the lower cut-off
for these effects, or if it's actually two weeks or even one. Caveat:
Polls such as this one in which not everyone in a population answers the
qeustions are frequently untrustworthy due to self-selection; a better 
approach would be to apply the poll to everybody who gives birth in a
certain hospital, for example. HOWEVER, these are the only solid figures
of any sort that are available anywhere, as far as I can tell, so the
results are the best ones in existance.

Anyone wishing to subject these data to further torture may e-mail me
for more details.

Paula Burch
pburch@bcm.tmc.edu
############################################################
V-A.  Supplies--Carriers 
------------------------ 
CARRIERS: While we're on breast pumps, I'd also like to mention the
insulated carrier that I use to transport breast milk from work to
home.  It's also from Medela, costs about $25-30 (again, I got it
through my HMO, but I imagine it's generally available), and I really
like it.  It's got a discreet blue canvas cover, it's light-weight,
has a separate compartment where either my electric pump or my manual
pump fit quite neatly, and it comes with bottles that fit the standard
nipple rings.  I mention the bottles because there's another carrier
out there that I frequently see advertised as "the best" which uses
non-standard bottles, so you'd have to do an extra transfer of the
milk to get it to a bottle with a nipple (Lac-Tote).  Just something
to check when you're considering carriers.
------------------------------------------------------------ 
Medela's new carrier kits are purple and green and look like exercise
bags. (I'm not kidding.)  You can put the Lactina in one compartment
and use the other for your lunch as well as your expressed milk.
Retail for $25 - $30. 
------------------------------------------------------------ 
I bought an insulated bag with an ice pack, and used that to carry
milk back and forth.  I found it kept frozen milk frozen for more than
3 hours.
============================================================ 
V-B. Suppliers 
--------------- 
Medela, inc.
   P.O. Box 38
   Crystal Lake, IL 60014
   (800) TELL-YOU
   (815) 455-6920 (can call collect)

Ameda/Egnell, Inc.  
   765 Industrial Drive 
   Cary, IL 60013 	
   (800) 323-8750
   (312) 639-2900

Bailey Medical Engineering  (Nurture III)
   1820 Donna
   Los Osos, CA   93402
   (805) 528-5781

Marshall Electronics, Inc. (Mag Mag, Marshall-Kaneson)
   Lincolnshire, IL 60069
   (800) 323-1482
   (312) 634-6300

Healthteam  (Gentle Expressions)
   627 Montrose Ave
   South Plainfield, NJ 07080
   (201) 561-4100

Motherwear, Complete Catalog for the Nursing Mother, 
   P.O. Box 114
   Northhampton, MA 01061-0114
   (800) 950-2500  
   (413) 586-3488

Right Start's phone number: 1-800-LITTLE-1

For more information about pumping and storing your milk, contact your
local LLL leader.  If you don't have a local phone number, contact LLL
headquaters at (312) 445-7730, 9-3 Central time.

Many of the small manual battery pumps are available at drug stores
and Toys R Us.

############################################################

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