Thursday, May 26, 2016

Breast pumps: A Blessing and A Curse

Loyd-B breast pump by Lopuco.

 "Eight breast pumps commonly seen in clinical practice were measured and ranked for desirability in eight categories, pressure range, pressure control, size and shape of nipple cup, volume accommodation, visual feedback, ease of handling and cost.  Three scored relatively high (Egnell, Kaneson, and Loyd-B), three scored low (Gomco, Davol, and Bintner), and two appeared to be frequently ineffective (Evenflo and Ora'lac)."  --abstract from paper entitled "An evaluation of breast pumps currently available on the American market."  Clin Pediatr (Phila), 1983 Jan; 22 (1): 40-5.

Breast pumps, either you love them or ya hate them!  The above pump was donated to me, in the 1990's.  The flange and bottle are glass, rubber stopper for bottle but the pump handle and tubing is plastic.  The working mom who donated this pump to me (at one time I had quite a collection--even a glass bicycle horn pump) loved it and highly recommended this pump.  It was a highly recommended hand pump in the 80's and 90's.  It had some drawbacks in that it was made of glass and so breakable.  And it required considerable hand strength.  So if a mom had carpal tunnel syndrome, the pump would be difficult to use. 

As you can see most of the pump companies in that study time period are no longer in business or have changed ownership and have a different name.  Evenflo pumps have the same complaints from consumers that this study mentioned:  frequently ineffective.  So a lot can change over the years but some things never change.  One of the problems with pumps is that after you buy them and undo the packaging they are no longer returnable.  They are considered a personal care product that cannot be returned, if opened.  Many of the consumer complaints about Evenflo pumps are that they worked for 1-3 times but then no longer worked.  So moms are stuck with a pump that doesn't work and they can't return it to the store and must deal directly with the company.  Moms have to have the purchase receipt to get a refund.  All this takes time and in the meantime the mom is without a pump.  If the mom has limited income, purchasing another pump maybe out of the question.

As an IBCLC before my retirement, I made recommendations to moms about pumping.  One of my main recommendations regarding pumping is that in the early weeks pumping should be avoided unless a mom was going back to employment early or had an infant that was refusing the breast or an infant that was hospitalized due to prematurity or medical conditions which created separation.  Why?  Because pumping means that a mom and her baby will be out of sync with each otherA breast milk supply is tied to the baby, the more the baby nurses the more milk is produced and the less the baby nurses the less that is produced.  Pumping increases a supply that a baby doesn't want or need(which is great if you need to build a milk supply to store because of future separation).  The baby controls supply unlike bottlefeeding (either infant formula or breast milk) where the mother controls the supply.  Unless the baby has some underlying medical condition or the mother disregards an infant's cues, the baby will signal the need for the breast.  The need for the breast is not just physical hunger but emotional hunger, the need for physical contact with the mother.  Disregarding either physical or emotional need in the baby will impact a mother's supply.  Learning to follow the baby's cues is at least a 6-week learning period for the first time mom.  If the mom is spending a lot of her time pumping and storing her milk in the early days, she may miss those cues entirely and rigidly follow a feeding schedule based on her belief system of what is appropriate.  I believe some of obesity problem is related to caregivers determining "hunger" in infants rather than looking for cues in their babies.  (bottlefeeding cannot satisfy all sucking needs in babies or the emotional need to be with mom if with a caregiver)  Mothers who disregard or misread the early signs of hunger in the baby, restlessness and mouthing fingers often have milk supply problems.  Mothers often wait til the infant is into full-blown screaming to bring the infant to breast.  Babies who are screaming are not ready to feed until they calm down.  Babies often refuse the breast and then some moms believe that the baby does not want to breastfeed.  There was a study done some years ago and breastfeeding problems are concentrated in the first 6 weeks.  Mothers and babies need those first six weeks to get to know each other and to have the time to solve the many problems that may occur during that time.  If moms start pumping and storing milk or they have to go back to employment prior to the 6 weeks, breastfeeding will often end before the mom and baby had a chance to get it working.

Are mothers getting correct information regarding pumping and breastfeeding?  The other day I read a breastfeeding blog where the IBCLC made a comment that annoyed me greatly.  She stated that if a baby slept too long a mother should pump her breasts.  No qualifications regarding the reason to pump.  Again, pumping puts a mom and baby out of snyc with each other.  Having a bigger milk supply than an infant can handle can lead to mastitis and can lead to more pumping because the infant cannot handle all the extra milk.  My answer for a baby sleeping too long is to wake the babyBabies have a light sleep and  a deeper sleep in which you cannot wake them.  If they are in a light sleep, they will often nurse without you fully awakening them.  The other possibility is to do nothing and wait and see what happens.  Some babies will sleep longer at times and your milk production will adjust to these variations.  Hand expression is also an answer to overly full breasts, pumps don't have to be used. 

I remember a home visit I made many years ago for a mom who asked for help because she was employed and her pump wasn't collecting enough milk.  She showed me her battery operated pump.  I tested it for suction and it had none.  So I was quite amazed that she was collecting any milk.  So I asked her if I could watch her use the pump and she agreed to show me.  The mom was literally hand expressing into the pump.  The pump was doing absolutely nothing.  I explained to her that she had excellent hand expression technique but her pump was useless.  She got another pump.

What happens to defective pumps, moms sometimes pass them onto friends but more often they end up in the trash can (unless the mom is able to return the pump to the company).  Most pumps nowadays are made of plastic and plastic in landfills does not biodegrade.  Only heat and sunlight degrade plastic, although scientists are working on creating bacteria that will degrade plastic.  Plastic material is a real problem for landfills and we now recognize an environmental problem in our oceans.  It takes a plastic bottle 450 years to degrade in the environment.

So manufacturing defective pumps in which moms cannot return to the manufacturer is not helpful environmentally (besides being a frustrating experience for mothers and possibly causing a mother to use infant formula).
But its not just defective pumps that end up in our landfills but also the fact that every year a set of new moms buy breast pumps, use them for a limited time and then add them to our landfills.  Although various pump companies (Hygeia and Medela) now will recycle your pump. But it is up to the mother to take responsibility to recycle.

And its not just breast pumps but all the plastic tubing (electric pump kits), bottles, teats (nipples) and pacifiers that are needed when a mom is separated from her baby that will end up in landfills.  "Plastics are produced from natural gas, feedstocks from natural gas processing and feedstocks from crude oil refining." 

Thus separating moms and babies has an environmental cost that goes unrecognized.  We don't think about the car that is needed for employment because public transportation in our smaller cities and towns is poor to nonexistent.  Thus there are more people on the road creating a larger carbon footprint on earth.  Or that an employed mom will need a more extensive wardrobe.  Or that a huge part of her paycheck will go for childcare and infant care. According to an article in the Gainesville Sun (dated in 2014) the average cost of infant care in Florida is $8300.  The title of this article was, "Compared with day care, college is a bargain."

Maybe it is time to rethink the ideology that separates mothers and babies. The improvement of the quality of life on this planet is a basic need that should be given due consideration.  Currently many employed moms have no choice but to be separated from their babies. But it is our society that has limited those choices or made them nonexistent.  Paying a parent to stay home with their babies and children, is an environmentally smart option.  And not just a smart environmental option but emotionally beneficial to mothers and their babies.

PS:  Yes we will still need breast pumps because separation of moms and babies will happen due to various medical issues or mothers who for various reasons do not want to breastfeed.  But does every new breastfeeding mom on this planet need a breast pump?  An article in The Atlantic should make us very aware of what we are creating when we have a society that believes that all breastfeeding mothers need a breast pump.  The article was entitled, A Brief History of Breast Pumps," by Megan Garber  in larger and bolder type than the rest of the article it states, "THE BREAST PUMP IS THE MACHINE THAT MAKES HUMAN MILK, IN ITS WAY, MARKETABLE."

Copyright 2016 Valerie W. McClain



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