Thrush – Yeast – Candida

Thrush is a common diagnosis when mom is experiencing nipple pain. Thrush is an overgrowth of a yeast that lives on the skin and in the gut of healthy humans. Thrush may also be referred to as candida albicans.

How Common is Nipple Thrush?

If you ask a group of moms, they’ll tell you thrush or yeast is very common. If you look at the research, a very different picture emerges. Mothers frequently complain of burning nipple pain, nipple damage, yellow or white discoloration in damaged areas of the nipple, sensations of heat or itching, and pain that radiates into the breast. These symptoms are then lumped together as thrush and treatment is prescribed often without a culture. Frequently, mom’s symptoms improve then return. Frequently, another round of anti-microbial treatment is begun.

The latest research on candida and breast yeast informs us that thrush is often the incorrect diagnosis. More women are shown to have staphylococcus aureus than candida, and not all women with one or both positive cultures have pain. In fact, only 15% of the study group experiencing nipple pain had yeast in the culture from swabbing the nipple. Even fewer, 9% had candida in the milk sample (Amir et al). Does ductal thrush even exist? Could it be something else?

Staph aureus has a white to golden color when present on the breast nipple. The common prescribed treatment for candida is miconazole or clotrimazole. Both of these drugs are effective in treating staph aureus as well as candida.

The largest common denominator in these studies on mothers experiencing nipple pain was nipple damage. Nipple damage is caused by a sub-optimal latch.

How Sub-optimal Latch is Misdiagnosed as Thrush

When a baby latches shallow to the breast and does not draw plenty of the areola into the mouth, the nipple is often exposed to inappropriate friction. The baby then must use the jaw and a clamping motion or bite to hold the nipple in the mouth. This can cause a very common condition called a vasospasm. The pressure from the poor latch causes an interruption of blood flow around the nipple. When blood flow returns to normal, a pain called a vasospam may occur. This pain can feel like shooting or burning pain in or around the nipple or deep into the breast. This pain can happen during, after, or between feeds. The solution for this pain is to fix the latch.

One contributing factor to shallow or clamp-down latch is a high arched palate in the nursing baby. These babies often have milk stains on the tongue because the tongue doesn’t rest against the hard palate and clear itself of milk. The milky tongue may look like thrush. Tongue-tie or ankyloglossia is another risk factor.

Sources:
Amir LH, Garland SM, Dennerstein L, Farish SJ: Candida albicans: is it associated
with nipple pain in lactating women? Gynecol ObstetInvest 41:30-34, 1995
Hale TW, Bateman TL, Finkelman MA, Berens PD. The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis. Breastfeed Med 2009;4:57-61.
http://www.placerconferences.com/wp-content/uploads/2014/05/G.Why-Does-it-Hurt.pdf

What to Do if Your Culture Came Back Positive for Yeast

Medications: Your health care provider can prescribe medications for both you and your baby that are compatible with breastfeeding. Many mothers feel anxiety about medications and breastfeeding. Remember, your doctor prescribes medications because they have more benefits than risks. If you are interested in reading study data on breastfeeding and taking your prescriptions, contact the Infant Risk Center.
Pumping Guidelines: If your baby depends on pumped milk, keep feeding the pumped milk. If you engage in informal milk sharing, it is wise to take a break from donating until the yeast is cured. If you donate to a milk bank, contact the bank about the medications you are using to clear the infection. If you have an open system pump, be careful. Change the tubing completely. The tubing can’t be sterilized well and should be changed if there is thrush. If you have a closed system pump that is functioning properly, just sterilize the pump parts correctly after each time you pump.

Nursing Guidelines: It’s perfectly safe and beneficial to nurse through thrush. The direct mouth-to-breast nursing is a closed system and transfers antibodies and biochemicals back and forth. Infant saliva on the nipple actually helps change the make up of the milk to meet a babies unique immune needs. The living cells in the milk help fight the infection during the nursing process. The sucking also can help relieve some of the discomfort babies experience when baby also has thrush.

Nipple Care: Your health care provider will probably provide a nipple ointment that is anti-fungal. There are many on the market that are perfectly safe for your baby’s mouth. You may want to consider saline nipple soaks to ease the discomfort and facilitate healing any damage. Using disposable breast pads can reduce staining in your nursing bras and clothing from the ointment.

Laundry and Dishes: Many moms are worried their bras, cloth breast pads, and cloth diapers are harboring yeast. Contact your cloth diaper manufacturer for instructions on how to strip your diapers. Other fabrics can be soaked in vinegar for 24 hours then laundered normally. Pacifiers and bottle nipples can be sterilized daily.

This blog post is informational only and does not serve to diagnose or treat any condition. See your healthcare provider if you suspect a nipple infection.

 

10 Questions with a Child Passenger Safety Technician

1) What is a CPST? Doesn’t the fire department check car seats?
 

CPST stands for Child Passenger Safety Technician. We educate parents and caregivers on the proper installation and use of car seats, boosters. and seat belts. SOME fire fighters are CPSTs as are some law enforcement officers, but not all. It is important to check for current certifications before letting anyone check your seats. 

2) Does the hospital check my car seat at discharge? What are they looking for?
Not usually. They need to know that you HAVE a seat, but most nurses are not allowed to touch it. Some hospitals do have a CPST on staff that can help prior to discharge. 

 

3) How do I know my seat is a good one? Is price an indicator? 

Every seat currently on the market is safe if used properly. They all pass extremely stringent testing before being sold to the public. Price is not an indicator of safety. A properly used $40 seat is safer than an improperly used $300 seat. The more expensive seats have more bells and whistles and comfort and ease of use features, but as far as safety is concerned – using ANY current, in date, seat properly is the best way to ensure your child is safe. 

4) Can I sit in the back with my baby and nurse him/her if I keep us both buckled?

As tempting as that sounds, it’s a very dangerous idea. If a crash were to occur while you’re leaning over your baby, your body weight would crush him. It’s much better to stop and nurse or pump a bottle for the road. 
 
5) How do I handle spit up on my car seat? Blow out diapers? Can I put a blanket or pad under my baby?

Always refer to the manual for cleaning instructions. Straps should never be machine washed, submerged or cleaned with anything harsher than a baby wipe or mild soap. This can compromise the strength of the straps by stretching them and/or weakening the fibers and cause them to perform poorly in a crash. Putting a bib on baby OVER the harness after buckling securely can help keep spit up off the seat. A chux pad or puppy potty training pad can be placed in the seat under baby to protect against diaper related messes. These are extremely thin, and as long as they aren’t placed in such a way that interferes with the harness, shouldn’t pose a safety risk. Some manufacturers make specific pads that can be used with their seats. When in doubt, a quick call or email to your seat’s manufacturer can be helpful in figuring out what is best to use.

6) I got a bunch of car seat covers and strap protectors as shower gifts. Can those be used with any seat or are some seats better designed for them?

I always say “if it didn’t come in the box with the seat, then don’t use it in the seat”. These items can claim to be “crash tested” but since there are no federal regulations for such aftermarket products that doesn’t mean anything, Manufacturers test their padding, harness covers, inserts, etc with their seats so they know they pass safely with them. The non-regulated products are not tested in this way. It’s always best to leave the testing to the crash dummies and not take a chance with our own children. 
 
Those products DO often work beautifully in strollers, though!

7) Why does everyone tell me to rear-face my seat so long? I worry that I can’t see my baby. 

EVERYONE would be safer rear-facing. But it’s kind of hard to drive that way. 😉 From age 12-24 months, children are 5Xs (532% to be exact) safer rear facing than forward facing. A young child’s vertebrae are in several pieces and don’t begin to fuse together until after the 2nd birthday and doesn’t finish until between 4 and 6 years of age. Rear facing provides maximum protection of this delicate spine by allowing the seat to cradle the child’s entire body keeping the head, neck, and spine aligned and fully supported and transferring the crash forces over a much larger area. In a forward facing seat, all that force is on the child’s head and neck since the only body parts supported are the hips and shoulders while the head and limbs are thrown violently toward the point of impact. The goal should be to keep a child rear facing to as close to their 4th birthday as possible with the absolute minimum being age 2 to turn forward.
 
8) My baby has reflux. Can I prop my seat or add a positioner?
Every seat has a recline indicator on it somewhere. If allowed (based on age and/or weight) by the car seat, the angle can be decreased as long as baby can support his head. Sometimes convertible seats can help babies with reflux because they tend to be more “L” shaped inside the seat as opposed to their “C” shaped rear-facing only (infant carrier) counterparts. As far as positioners go, as I stated above, if it didn’t come with the seat, then no, they should not be used*.
 
*A few manufacturers DO make accessories for use with THEIR seats that have been tested. Always check your manual.

9) We take long car trips often. Any tips for helping my baby stay relaxed in the car seat? I don’t want to have a car screamer.
Car screamers are the worst. I’m on my second one. Here is a list of some things to try to make traveling more pleasant (and quieter).

– Good air flow. No one likes to be too hot or too cold in the car.
– White noise. Sounds such as beach waves, thunderstorms, and rain forest noises can help calm baby. Even just an out of range, staticky radio station or open windows can be enough.
– Soft, lightweight toys that are special and only for the car. Steer clear of anything hard, heavy, large, or battery operated as these can be dangerous projectiles in a crash. 
– A lightweight, plastic mirror can help rear facers feel closer to mama and daddy in the front seat. These do also pose a projectile risk, so be sure to find one that is soft, fits your car’s head restraints well, and attaches firmly if you choose to use one.
– A backseat buddy can help entertain baby. Having the non-driving parent in the back can make it a little more fun back there!
– A backseat buddy can help entertain baby. Having the non-driving parent in the back can make it a little more fun back there!
– Frequent stops so baby can eat, get a clean diaper, and stretch his legs are very important (for mama and daddy, too!). Usually, every 2-3 hours is the longest you’ll want everyone to remain strapped down. Let them run off that extra energy that they siphon from us. 😉
– Traveling at night or leaving at nap time can sometimes make things easier, too. A sleeping baby, is a quiet baby. Unless they snore.  
 

10) Can I pump and bottle feed my baby on car trips right in the seat? Can I prop the seat to help him/her not choke?
Keeping in mind the projectile risk the bottle poses, as long as baby remains properly strapped into a properly installed seat, feeding a bottle while driving could be a good last resort. The best idea would be to stop and feed at a rest area, though.

 

Bonus Question 11) Share your favorite breastfeeding memory!

When my girls first glance their eyes up at me while nursing and give me that milky smile is always my favorite. It’s kind of like a little “thank you” for the gift I’m giving them and the hard work it can sometimes be to do it. ❤
Rori Holisky is a mother of two little girls, ages 4.5 years and 5.5 months and the wife of a law enforcement officer. She became a Child Passenger Safety Technician in 2013 and started Birth to Booster about a year later. Her hobbies include playing with car seats, watching Firefly and Buffy the Vampire Slayer, and sewing. 🙂
 
www.Birth2BoosterSafety.com
https://www.facebook.com/birthtobooster

How Do Moms Pump Enough to Return to Work?

Many moms want a safety net of pumped milk in the freezer for their return to work away from their babies. While it’s only necessary to have enough milk saved for the first two days back at work, many moms want to save several days or even weeks worth of feedings during their maternity leave.

Please read What to Expect When Pumping to trouble shoot and get the most out of your pumping experience. This article addresses how to juggle pumping during your maternity leave and during the working day.

When to start building a “stash”

Most women start with over production. The first 10 weeks of breastfeeding are the easiest for milk collection. This is also a critical time for conditioning the body to respond to a pump. Ideally, moms should nurse on cue and spend a great deal of time resting skin to skin with their babies for the first 2 weeks. Once baby has regained birth weight, around day 10-15, it’s time to try pumping.

Milk collection is easiest in the morning hours when the milk making hormones are highest. Beginning at this favorable time will help make pumping a more positive experience. After nursing the baby, pump either one or both sides for 20 minutes each. Even if the milk stops flowing, continue pumping for 20 minutes per side.

Weeks 2-4, pump one time per day in the morning after nursing. Expect to collect 1-2 ounces each day. Remember: 20 ounces is enough milk for about 16 hours of mother-baby separation.

If you wish to increase your daily milk collection, add a second daily pumping session weeks 4-6. Pumping only twice a day will help you collect several days worth of milk before returning to work.

If your baby cues to nurse after pumping, just nurse. The breasts are never truly empty until you wean. The more milk removed, the faster the glands work to produce more milk. No pump is as efficient as a baby who is properly latched. There is no need to feed the baby the pumped milk in place of nursing.

If your maternity leave is longer than 6 weeks, continuing pumping 1-2 times per day as is possible for the duration of your leave. This helps maintain a conditioned response for more efficient pumping in the future.

When to Pump at Work
No two work environments are the same. No two work days are the same. Not every work environment allows for predictable or scheduled pumping sessions. Things to consider:
– aim to pump every 1-3 hours. This is a range. Babies and breasts are flexible.
– don’t feel trapped on a schedule
– if you anticipate a long meeting or event you cannot break out of, consider pumping once an hour for 2-3 hours beforehand and/or afterward
– your body does not require you to pump on a set schedule just as your baby does not feed at set time
– a hands free pumping bra can help you pump during your drive to and from your work location
– hand expression may help moms who have a short break but can’t make it to the pumping room
– taking a lunch break to nurse your baby may be easier than pumping as frequently at work

Gallery of Pumped Milk

Human milk changes color, texture, and composition throughout the day and as the baby ages. This gallery of milk is for informational purposes so mothers can feel confident that their milk still “looks good.”

Some important points on the look of pumped milk:
– The visible fat layer is not an indication of how much fat is in the milk. Human milk doesn’t fully separate when left standing.

– Human milk varies in fat content from 3-10% throughout the day.

– The color of milk can and will change

– Human milk is about 87% water. Watery looking milk is normal.

– Milk can look blue, white, or other colors. Diet and food coloring may impact the color of pumped milk.

– Separation of milk is not an indicator that the milk is spoiled. Separation is normal.

 

Our gallery is growing! If you’d like to submit a photo of your pumped milk, please include the age of your baby (or babies for twin and tandem nursing moms) and time of day you pumped to milkmakingmom [at] gmail.com

We will keep your identifying information confidential.

This gallery is for informational purposes only and is not meant to treat or diagnose any condition. It is our goal to showcase the wide range of milk pumping experiences.

 

This is refrigerated milk that a tandem nursing mother pumped on day 3 postpartum. She has heavy oversupply.

This is refrigerated milk that a tandem nursing mother pumped on day 3 postpartum. She has heavy oversupply.

Milk pumped after feeding 5 day old baby around midday.

Milk pumped after feeding 5 day old baby around midday.

This milk was pumped by a mom with oversupply at 3 days postpartum.

This milk was pumped by a mom with oversupply at 3 days postpartum.

This milk was pumped at work around 10:30am. Baby is 12 weeks old.

This milk was pumped at work around 10:30am. Baby is 12 weeks old.

This milk was pumped at 8:30AM. The baby is 4 months and 6 days old. The previous pumping session was  4:00AM. This mom pumps 6-8 times daily.

This milk was pumped at 8:30AM. The baby is 4 months and 6 days old. The previous pumping session was 4:00AM. This mom pumps 6-8 times daily.

This milk was pumped while the baby was nursing on the other side. The baby is 11 weeks old. The milk was pumped at 6:30am.

This milk was pumped while the baby was nursing on the other side. The baby is 11 weeks old. The milk was pumped at 6:30am.

What to Expect When Pumping

Expressing milk for your baby can be one of the most affirming or daunting tasks. Filling your pumping bottles to the max can be a real boost of confidence, but is that normal or optimal?

General recommendations for how to pump milk

1. A double electric pump is ideal for mothers who will be expressing milk frequently. (For more information on how to choose a pump, see Finding Your Perfect Pump)
2. A properly fitting flange (the horn or bell shaped piece that presses to the the breast) will be the most comfortable and ensure optimal milk expression
3. Pump both breast simultaneously for about 20 minutes.
4. Normal pump output is 2-4 ounces total from both breasts from one 20 minutes double pumping session.
5. Pump output is not an accurate gauge of milk production. Pumping is a developed skill that improves over time.

Getting a Good Fit

Fitting your pump flange can be a tricky process. Breasts change over time. It is completely normal for a mother to need to change flange sizes over the course of breastfeeding. Many pumps now come with a range of flange options or additional flanges that you can purchase separately. The best fitting flange at week 1 may not be as comfortable or effective at week 28. Human bodies are not symmetrical. It is normal to use different flange sizes for each breast.

Most women use trial and error for testing their flange fit. Learning to hand express milk can also help determine where on the areola the flange should rest for optimal pumping. The flange should be in contact with the same areas of the areola that a woman stimulates to hand express her milk. The flange should not rub the nipple. It should provide even pressure to the areola.

Tips for Double Pumping

Some women find it difficult to hold the pump flanges simultaneously. Pumping bras are easy to find at most baby product stores. They hold the pump flanges for you. This hands-free option means that working mothers may be able to do other tasks while pumping. A sports bra with holes cut in the cups can work in a pinch if you don’t have a pumping bra. Simply feed the flanges through small holes in the bra.

Normal Pump Output

The general understanding of pumped milk output is that 2-4 ounces is normal for both breasts combined. You may notice that one breast expresses significantly more milk than the other. You may notice that time of day influences how much milk you collect. It’s important to remember that pumping milk is not a predictable process, just like all things with parenting. Here is a list of common pumping experiences that cause mothers to worry about their milk supply though they are usually perfectly normal:

–  higher pump output in the mornings, lower pump output in the afternoons

– pump output that decreases over time as the baby ages (most women begin with oversupply that noramlizes between 6-12 weeks postpartum)

– one breast pumping a high volume, one breast pumping a low volume

– pump output decreases during menstruation and/or ovulation

– inability to pump the breast “empty,” milk continues to flow after the standard 20 minutes of pumping

– need for new flange sizes over time

– change in nipple shape over time

Blame the Pump First

Some women notice sudden changes in pump output. Always blame the machine before your breasts. Pumps have parts that are designed to be replaced during the course of time. Membranes and tubing are susceptible to small holes and degradation. If these parts are not at top shape, the pump will not work properly. Assembly errors (user errors) are also common. If your pump is not functioning, check  the pump first. Chances are mom is perfectly lactating and the pump needs a tune up. A good rule of thumb for open system breast pumps is to change the tubing every 2-3 months to avoid contamination and improve pump performance. The membranes on open systems pumps often function best when replaced monthly.

Top Tips for Improved Pump Output

1. Make sure the pump is in good working order, properly assembled, and properly fit to the breast

2. Pump in a relaxing environment to facilitate the strongest letdown response. Some mothers look at photos of their babies or watch films on their smart phone. Smelling an relaxing aromatherapy candle or even a “dirty” baby blanket can help some mothers.

3. Heat and massage the breasts before a pumping session. A microwave rice sock is easy to transport and can be tucked in your bra a few minutes before pumping. Rub the breasts all over in firm circular strokes.

4. Stimulate the nerves to the breasts. The thoracic spinal nerves that correspond to the breasts are T3, 4, and 5. They can be stimulated by rubbing your back against a door jamb. Think “bear scratching back on tree.” Or ask your partner to rub your spine a bit while you pump.

5. Drink a glass of water while you pump. It may help relax you and feel more in control of the process.

6. Hand express for about 5 minutes after pumping. Some women are able to express 50% more milk by hand after they pump. Remember, the breast is never truly empty until full weaning happens.

7. Make sure your baby is being fed appropriate amounts while you are away. 1-1.25 ounces is per hour of separation is the recommended amount. Many moms find their pump output is normal but the baby is being overfed. (more information see Bottle Feeding Human Milk)

8. Contact an LC to develop a pump routine that matches your pump output needs. Some mothers need an individualized plan because of workplace constraints or parenting demands.

Bottle Feeding Human Milk

Storage

Guidelines for storing human milk vary slightly depending on the resource you use. This article cites the recommendations from La Leche League International (as posted in the web FAQ) and the Centers for Disease Control website on breastfeeding. Mothers should be encouraged to test their milk whenever they doubt its freshness by smell and taste. It’s impossible to discern freshness visually. Human milk has a wide range of normal colors. The separation of fat can vary greatly as well. When in doubt, throw it out.

On the counter: 4 hours according to LLLI, 6-8 hours according to CDC In a cooler on “blue ice” packs with packs in contact with milk containers: 24 hours according to CDC

In the refrigerator: 3-8 days according to LLLI, 5 days according to CDC
In the freezer (do not store milk in the freezer door. It will be exposed to more drastic temperature changes in the door compartment.): 6-12 months according to LLLI, 3-6 months according to CDC
In a sub zero “deep” freezer: 6-12 months according to CDC

For minimum waste, store milk in 2 ounce portions. Some mothers find storing in 1, 2, and 3 ounce portion gives them more flexibility and less waste.

Heating

Thaw frozen milk in the refrigerator or in a bowl of warm water. Do not microwave. Do not submerge in boiling water. Milk storage baggies are not designed to withstand high heat.

Milk that is thawed can be heated in the bottle in a bottle warmer or pan of warm water. Remember, the milk need only be heated to body temperature, not made hot.

Milk will naturally separate after expression. Swirl heated milk bottle gently to mix fat layer back into solution. Do not shake. Shaking puts bubbles in the milk making the flow out of the bottle less smooth. Bubbles may increase gas. Human milk contains fat chains of long and short lengths. Shaking may disrupt the fats.

 

Choosing a bottle and artificial nipple

A slow flow artificial nipple is ideal for the duration of breastfeeding. Babies who alternate between breast and bottle will continue with a slow flow nipple until they transition to a cup. Slow flow nipples will keep your baby bottle feeding on a pace more similar to the breast to make the transition back and forth easier.

No brand of artificial nipple creates a latch like breastfeeding despite marketing claims. In fact, advertising a teat this way is a violation of the World Health Organization’s international code of marketing breast-milk substitutes. There is no shape, material, or insert that is like a human breast. When choosing an artificial nipple, the one that is slow flow, able to be sanitized, non-allergenic, and agreeable to the baby is the right choice. What works for one family may not work for another.

Breastfed babies rarely have stomachs larger than 3-5 ounces, even at 6-9 months. When choosing a bottle, small bottles are sufficient. Large bottles of 6 ounce capacity or more are for formula feeding.

Many parents are concerned about chemicals in plastics. Many bottle companies now offer BPA free plastics. Glass bottles are also growing in popularity. Glass bottles now are on the market that have rubber sleeves to help prevent shattering. The type of bottle a family chooses is a personal decision.

Paced Bottle Feeding

1. Hold baby mostly upright. Babies cannot regulate the flow of a bottle when lying on their backs or reclined.
2. Hold bottle parallel to the floor. It’s okay if some air is in the tip of the nipple.
3. Place the tip of the nipple on the baby’s upper lip. Baby will open the mouth wide. Gently insert bottle nipple into the mouth completely. The baby’s lips should be flanged at the base of the nipple.
4. Let the baby drink 1 ounce. Gently tip the bottle down to give a rest break without breaking the latch. Babies are able to stop the flow of the breast easily. Gravity prevents babies from controlling the flow of a bottle the same way. These short breaks help the baby bottle feed more similarly to breastfeeding and give them a chance to cue fullness.
5. Feed a second ounce and provide a second break by removing the bottle nipple from the baby’s mouth.
6. If baby shows hunger cues, switch the baby to the other side of the body. Breastfed babies coordinate left-right because they are switched from side to side. The second half of the feed should be done with the care giver holding the baby on the opposite side.
7. Latch the baby to the bottle nipple and feed again just like instructions 1-4. Continue to feed ounce by ounce with breaks in between to allow baby to burp and cue fullness.
8. The baby should spend as much time at the bottle feed as he would at a breast feed.
9. Never encourage a baby to finish a bottle. Always follow cues of hunger and fullness. Scheduled feeds are not recommended by any health organization.

Why is pacing the feed so important?

Many mothers misjudge their milk supply due to incorrect bottle feeding. A baby held in a reclined position during a bottle feed will have milk flood the mouth due to gravity. Babies are smart. They will swallow the milk in order to protect their airway. They don’t want to aspirate the milk into their lungs. This is why many mothers report that their baby “sucked down” a bottle rapidly.

Babies bottle fed this way generally have an easier time feeding at both the breast and bottle. So called “nipple confusion” is decreased. Many babies will learn the flow differences of reclined bottle feeding and breastfeeding. These feeding methods use different facial muscles. Feeding at the breast is shown to provide optimal craniofacial development. Paced bottle feeding can help a baby enjoy the benefits of breastfeeding when mother and baby are together.

Finding Your Perfect Pump

The perfect pump is the one that helps you have a healthy breastfeeding experience. With all the brands and attachments on the market, how do you choose? Here is a breakdown of what’s out there, and what the label really means.

Manual vs. Electric

Manual breast pumps often pump one breast at a time using a squeeze or trigger device to create suction. The strength and speed of the suction is adjusted and regulated by the woman’s hand pressure on the pump device.

Electric breast pumps use an electric motor to create suction. These motors may have battery or plug-in power options. Electric pumps come in single and double, meaning they may pump only one breast or both breasts at the same time. Most of the pumps other mothers will recommend are double electric pumps. They are commonly used by mothers who work outside the home or have extended separations from their nursing baby. Electric pumps have speed and suction adjustment options that work in a variety of ways. Some have dials. Others have manual rhythm settings.

One of the first breast pumps pre-1900 made from glass and brass. Modern technology has come along way.

Open System vs. Closed System

Electric pumps use a motor to create suction. The motor system is either “open” or “closed.” An open system pump connects the pump flange to the motor directly with tubing. Air and fluid can be exchanged in the tubing.  A closed system pump has a membrane between the pump flange and the tubing. Air and fluid cannot be exchanged in the pump tubing. All hospital grade pumps are closed system pumps. The benefit of a closed system pump is that the membrane protects milk from being contaminated by fluid or particulates from the motor or tubing.

Closed system pumps are the only type of pump that can be approved for multiple users. Currently, only Hygeia makes a closed system pump that is FDA approved for multiple users AND is available commercially for purchase. Hospital grade closed system pumps are only available for rent.

Many top manufacturers sells open system pumps. These pumps generally work very well, have strong motors, and come with many features that make pumping on the go easier. The only caution is that there is a possibility of milk back-flowing through the tubing and into the motor housing. There is no way to sanitize the motor. Mold may grow in the motor housing. The tubing, flanges, and bottles can all be sanitized. This is one reason it is not recommended to buy a pump secondhand or use a friend’s pump that is not FDA approved for multiple users.

Pumping bras make hands-free pumping easier for working moms.

International Code for Marketing Breast-milk Substitutes

The US does not have laws in place to enforce the International Code for Marketing Breast-milk Substitutes. Companies may or may not voluntarily comply. Some pump manufacturers comply while others do not. You can read the full Code here to get a better understanding of how the Code seeks to support maternal and infant health. Mothers “vote with their dollars” when they purchase a breast pump, so choosing a company that truly supports breastfeeding is important to many mothers.

Hand Expression

All nursing mothers benefit from learning and practicing hand expression of their milk. Hand expression is safe, sanitary, does not require electricity, and is completely free. A mother just needs a bowl or bottle to collect her milk. Mothers can learn different expression techniques from taking a breastfeeding class, working with an LC, another breastfeeding mother, and educational films. Mothers who use hand expression can collect milk for their babies as effectively or more so than mothers using a pump, when they have mastered the technique.

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