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How to Choose the Best Breast Pump

By Juliet Spurrier, MD ⋅ Mom-in-Chief
Wednesday April 12, 2017

A breast pump is typically a nursing mother's "close companion" during lactation. For some, a double electric breast pump can make all the difference between a stressful breastfeeding experience and a successful one or a lackluster supply and a robust one. Thus, this is one baby-related item that is worth well-researched consideration. However, breast pump specifics can be very confusing which in turn can make selecting the right one for you a real chore. There exists a plethora of manufacturers and models in addition to technical terms such as "2-phase expression", "closed system," and "massage mode" that may propel already sensitive hormones through the roof.

This article's focus is on "Everything You Need To Know about Breast Pumps." In it, we will guide you through the world of breast pumps and answer fundamental questions. Also, we highly recommend reading our Article titled Best Practices for Handling Breast Milk.

To also help you on your journey to finding the right breast pump for you, we tested 10 of the most popular single-use breast pumps on the market in an array of varying brands as well as both double electric and manual to find the best. We evaluated them comparatively them side-by-side on the following important criteria: efficiency, comfort, ease of use, portability, hygiene, and acoustics. You will find the results here in our Best Breast Pump Review.

Will you Need a Breast Pump?


Whether you are exclusively or partially feeding your baby breast milk, it is highly likely that you will use a breast pump somewhere along the way for one purpose or another. The frequency of its use depends upon your lifestyle and milk production as well as baby's appetite.

Typically, a baby's latch and sucking power during breastfeeding produce superior stimulation and volume in comparison to what a pump can accomplish during the same time frame. So, keep in mind that pumping may not produce as much milk as during a nursing session with your baby. Also, know that every mother's letdown and production can widely vary. While one may produce 5 ounces a side in a 15-minute pumping session, another mother may yield 2 ounces or less a side.

The following are common reasons why mothers choose to purchase and use a breast pump.

Engorgement


Breast pumps can feel like lifesavers when mom's milk comes in. Some women have significant engorgement to the point where baby can't possibly relieve mom of her load. Also, it can be difficult for newborns to latch onto an engorged breast, so a pump can come in handy to help reduce volume and soften the breast before baby prior.

Insufficient Supply


Pumps can also play a vital role in stimulating milk production when a mom has with little supply. The physiology of breastfeeding is a demand-supply loop. By pumping for 10 to 15 minutes after baby has already nursed, the extra stimulation will typically create a more robust milk supply over time.

Challenging Mother-Baby Nursing Dyad


Meal time with Medela.
Occasionally, mothers face great difficulty getting their baby to latch on and suck properly. The reasons for this can be many such as inverted nipples or a baby who is ill or developmentally delayed. In this circumstance, a mother needs a pump if she chooses to feed her baby expressed breast milk. To keep up with a full or part-time pumping schedule, these women often need powerful pumps to keep milk supply going. In this situation, often a stronger, multi-user pump like the Medela Symphony can be reasonably rented for short or long term use. Multi-user pumps are discussed below, although we did not test them in our Best Breast Pump Review.

Mother Working Out of the Home


All pumped and ready for baby.
Mothers who work outside of the home are typically away from their baby for extended periods of time and rely on breast pumps to create sufficient supply and demand so that they can continue to nurse. Breast milk is certainly the most nutritious and healthful option for baby, and it takes a great breast pump and maternal dedication to keeping this train going.

For mothers anticipating a return to work, it is important to build a stockpile of frozen breast milk. When to begin and how much to store depends upon a mother's level of milk production as well as how many hours a week mom will be away. If mom is an overproducer, lucky her! If supply is a challenge, starting the storage process earlier may be helpful. Remember that supply is usually more robust in the morning, so occasionally pumping after a morning feed is one approach. Or, when a baby takes only one breast, pumping the other will get you there over time. Regardless, breastfeeding while back to work requires daily dedication and preparation to keep production going. It truly is a labor of love!

Mothers In the Home


For those moms who have the job of caring for their little one(s) full-time, a breast pump can be an integral tool for reasons already discussed: engorgement, low supply, and difficulty with latch and suck. But for the mother who is with her baby 24/7, this is a particularly nice reason to invest in a pump: Every new mama works hard (whether in our out of the home) and needs as well as deserves time away. By having a supply of expressed milk available, mom can get away for few hours to run an errand, exercise, or have a precious date night. Dads can also get in on the feeding action and bond with their baby by giving them expressed breast milk via bottle while mom gets much-needed rest or personal time.

The Affordable Care Act and Breast Pumps


Signed into law in 2010, the Affordable Care Act (ACA), a.k.a. "Obamacare," requires commercial health insurers to include the services of "breastfeeding support, supplies, and counseling" in the comprehensive health care of women. This ACA law includes coverage of a breast pump for lactating women. The caveat here is that "coverage" may or may not pay for the entire cost of the pump, and this can vary company to company, plan to plan, and network to network. Yikes!

Obtaining a breast pump through your health insurance can make a big difference on your pocketbook at zero to less out of pocket cost when compared to buying without it. However, know that it will take some legwork and make plans in advance, if possible. For example, some insurance plans will allow filing a claim no earlier than 30 to 60 days before delivery while some will only do so once mom has delivered and up to a year past childbirth. The 30 to 60-day policy does make sense because if you end up having a baby prematurely, you may need a particular prescription for a hospital grade breast pump, typically a rental like a Medela Symphony.

The basic steps to obtaining a breast pump through health insurance are the following:
  • Prescription — A mother must get a prescription/prior authorization for a breast pump from her physician. If you plan on pumping frequently or have a history of low milk supply, make sure your doctor writes a prescription for a double electric one. Though manual breast pumps do fill a particular niche, double electric pumps are much more efficient. Additionally, manual pumps are much less expensive than electric, so if insurance covers the bigger expenditure, take advantage of this opportunity.
  • Submission — The prescription needs to be submitted to mother's insurance company.
  • Choose a Pump — Upon submitting the prescription, a selection of covered pumps will be provided as well as one or more Durable Medical Equipment (DME) companies through which you can order. You may also find out further information about your coverage such as if your insurance company will only cover a set cost or whether or not you will be responsible for a copay as part of this transaction.
  • Order Pump — Contact contracted DME company and place an order as well as pay any remaining costs not covered by insurance.

But, what happens if a mom prefers a different style or brand of a pump than her insurance allows? This can feel like a great roadblock, one where many may choose to quit the coverage process altogether. However, many DME companies may offer "upgrades" for a determined out of pocket cost. With this information, we encourage you to take this opportunity to shop around for the best price and package with reputable retailers to ensure you are getting the best deal.

Lastly, if you prefer to have an advocate do the behind the scenes work for you, contact your health insurer to find out which DME (Durable Medical Equipment) company they contract with as some like Aeroflow will do just this. Their services include contacting your insurance to determine its coverage policies for reimbursement, requesting a prescription from your doctor, filing a claim with your insurance, and mailing a pump directly to your door. They provide access to highly regarded breast pumps including award-winning Spectra S1 and Medela Pump in Style.

Types of breast pumps


There are so many brands and styles of breast pump available that it can be tough to decide which one is right for you, other than what your friends have to say through their experiences. You may also find that your needs may be very different from theirs. Each pump has its strengths, weaknesses, and individual price point.
Tubing and motors and bags galore!  BabyGearLab's Breast Pump line-up!
Tubing and motors and bags galore! BabyGearLab's Breast Pump line-up!

The two main categories of breast pumps are manual and electric. There are pros and cons to each, and there are reasons why one or the other may work better for you. Read on as we define each a bit more clearly.

Manual Pumps


Manual pumps are hand-operated and pump one breast at a time via a flange and manual lever which creates suction. They are less expensive than electric pumps as well as light and small so easily fit into a purse or carry-on for an outing, overnight, or travel. A good manual pump should be able to express a decent amount of milk, comparable to an electric pump. However, this process is certainly more time consuming and labor intensive.

They are best suited for the sporadic pumper, ideally, once milk supply is well-established. Even if mom has an electric pump, manual pumps are a nice companion piece for the breastfeeding mama. Once a baby is down to a few feeds a day, a manual pump is a definite space-saver when out for an overnight or a short work trip.

Electric Pumps


Electric pumps are attached to a motor and run via an outlet or battery power. Most breast pumps now have the following options: AC adapter, car adapter, a rechargeable battery, or a battery pack. They are available in single and double versions. Single Electrics pump one breast at a time. An example of such a pump is the Medela Swing (below left). Double Electrics (for example, the Medela Pump in Style below right) pump both breasts simultaneously which can be a huge time saver. Typically, doubles can also be easily configured to pump just one breast if desired. All of the electric pumps we tested in our review are doubles.
Medela Swing is a single-user  single flange electric pump.
Medela in Style Advanced with on the go tote.  Above we see the pump built into the tote bag  along with all the accessories included with your purchase.  A great value in our opinion.

If you pump more than 3x/week, a double electric pump is a very worthwhile investment. Working moms, moms with low supply needing more stimulation, or a mom who exclusively feeds her baby pumped breast milk all fit into this picture. Double electric pumps are just so much more efficient than the single versions and if you need to pump only one breast converting a double to a single is easy, so you have a 2-in-1 setup. Just close off one of the suction ports into which the tubing attaches.

What is a Hospital Grade Pump?


The FDA regulates breast pumps as they are considered to be medical devices. However, the term "hospital grade" is not recognized by the FDA and does not equal safety or hygiene. Our advice: do not let the term "hospital grade" influence your purchase as manufacturers can make this marketing claim without it having a consistent definition.

Therefore, the FDA advises to pay closer attention to the terms multiple-user and single-user. Understanding the differences between each and when to buy a single-user versus when to rent or invest in a multi-user can make a big difference in the beginning and sometimes even in the long haul for some moms.

Multiple-User


Medela Symphony is a multiple-user  closed system  double electric breast pump that is a popular rental due to its strength and high price tag. It is an effective option for moms having difficulty in establishing supply or those that are exclusively providing their babies pumped breast milk.
Multiple-user breast pumps are typically used by hospitals and lactation consultants as well as available for home rental, like the Medela Symphony. If used and maintained properly, they can safely be used by multiple mamas. To make this work, each user needs to have their tubing to attach to the pump as well as accessories into which the milk is pumped. This is likely where the term "hospital grade" originated, referring to multiple-user capability as well as increased strength over single-user pumps. Multiple-user pumps are commonplace in NICUs where mothers with preemies who can not yet nurse can initiate lactation, pump, and save milk for their newborn once they are ready to begin oral feeding. As these mothers are lactating without the much more efficient suction power of a newborn, increased power of multi-user pumps are essential to their long-term breastfeeding success.

Single-User


All of the pumps we tested in our review are single-user models. Single-user breast pumps tend to be much less expensive than multiple-user ones and technically, manual pumps are single-user as well. Single user electric pumps have either open systems or closed ones.

An example of an open system pump is the very traditional Medela Pump in Style which was given our Best Value award in addition to their single electric pump the Medela Swing. An open system does not have a barrier between the milk collection kit and the pump which can potentially cause issues. Because air is drawn through the pump to create suction, without a barrier, pumped milk is technically exposed to matter in the air like dust particles, dander, pollution, bacteria, and viruses.

In addition, in an open system, contamination can stem from the opposite direction as well. If milk gets into the tubing, care needs to be taken to clean the tubing and ensure that it is completely dried out before using the pump again. If milk is inadvertently left inside the tubing, mold can grow inside and then ultimately transfer to the motor which can not be cleaned. To painfully illustrate this point, we came across a lactation consultant's Facebook post where she took off the faceplate of several used open system pumps and comparatively photographed them to create a visual for her clients of why re-using, selling, or giving them away is out of the question. All we can say is that a picture is worth a thousand words. Thus, if you are considering purchasing a breast pump with an open system, it is particularly important to pay close attention to the manufacturer's manual which outlines operating, cleaning, and maintenance instructions.

As of the date of this writing, the effects of these health and hygiene concerns with open system pumps have not been studied, and illness in healthy babies as a result of contaminated breast milk has not been documented in the last 35 years. One circumstance in 1979 where five preemies developed blood infections when fed the same donor breast milk highly contaminated with bacteria originating from an electric pump's tubing and safety trap. This study does not relate to a healthy newborn, however, as preemies have weakened immune systems. Also, the specifications of the pump in this mini-outbreak are unclear, but the study does indicate that "institution of proper sterilization of the pump equipment controlled the outbreak."

On the flip side, however, open system breast pumps like the Medela Pump in Style have been successfully used for years by mothers. And, Medela does have a clear instructional assembly video which covers how to remove the pump's faceplate to clean the diaphragm and inner area regularly as well as how to clean and air dry tubing if milk or condensation should enter it. Though regular cleaning and maintenance do help significantly, it is still perplexing to us why open system breast pumps are still in production and circulation when the technology for single-user, closed system pumps is now readily available.

The Spectra S1, Editors' Choice, and the AVENT Comfort Double Electric are two examples of closed breast pump systems. A closed system does have a barrier between the milk collection kit and the motor. Thus fluid is unable to enter either the suction tubing or motor. Also, the barrier prevents air impurities from being introduced into pumped breast milk. If cared for appropriately, they are more hygienic. However, this doesn't mean they should be handed down or sold for other mom's use (more on this below).

Do Not Buy or Borrow a Used Single-User Breast Pump


We know that even single-user electric pumps can feel like an exorbitant cost. Thus it might be tempting to borrow one from a friend or buy one used. However, it is just not worth the risk of using a hand-me-down from another mom. Simply put, don't do it.

As well, single-user breast pump manufacturers do not recommend this practice.

It is not advisable to use a previously owned breast pump. Breast pumps are single-user products, or personal care items, much like a toothbrush, and are registered with the FDA as single user items. For safety, breast pumps should never be shared, resold, or lent among mothers. Medela actively discourages moms from re-using or re-selling previously owned breast pump equipment. --Medela

Allow us to delve into the details of why it is important to purchase your single-user breast pump.

Health and Hygiene


Because humans can harbor infectious disease without even knowing it, sharing personal care products including single-user breast pumps (manual pumps included) is not recommended, even with a good friend. Breast milk is a biologic substance which can harbor HIV and CMV and be transmitted unknowingly. Also, if a mother with cracked, bleeding nipples pumps, blood comes into contact with external pump parts. Despite good washing, bacteria and viruses can still be transmitted. Thus, it is also important to always use personal milk collection kits.

There are certain risks presented by breast pumps that are reused by different mothers if they are not properly cleaned and sterilized. These risks include the transmission of infectious diseases … FDA believes that the proper cleaning and sterilization of breast pumps requires the removal of any fluid that has entered the pumping mechanism itself. If proper sterilization of the breast pump cannot be achieved, FDA recommends that it not be used by different mothers.--FDA

Single-User Pumps are simply not meant to be passed along. With open systems like the Medela Pump in Style Advanced and new milk collection kids will not solve the problem. Over time, an open system pump is more likely than not to have breast milk and mold breach inside the motor which can not be cleaned or disinfected properly. On the other hand, closed system pumps like the Spectra S1 do not have these issues if a new collection kit is used. However, they are manufactured as single-use as motor life can only last so long. More about this below.

On the other hand, Multi-User Pumps can be used by more than one pumping mama if they are cleaned and cared for properly. Thus, if someone chooses to make the costly investment of buying one like the Medela Symphony at a price tag of around $1500 or higher, these can be passed along if they have been cared for well.

Motor Lifespan


Most single-user electric breast pumps are designed to be used for about one year with one child. The warranties among manufacturers and models may differ, so this is something to consider when purchasing. Also, manufacturers typically void a single-use breast pump's warranty if used by more than one person.

In a nutshell, if you are pumping three times a day for a year, eventually the motor is bound to lose its strength. This also means that hand-me-downs aren't likely to have as much strength as they once did when they were new. We firmly discourage a new mom from relying on a used electric breast pump not only for the health and hygiene concerns detailed above but also because it is very likely to have lost significant power. If you are ever concerned about your pump's vim and vigor, we advise taking it to a rental location where they are likely to have a vacuum tester and can measure its suction capacity to see if appropriate levels are being reached.

What to Do with a Used Single-User Pump When Use is Over


Since it is not kosher to pass on these personal use devices, what to do with them in the end? There are two ecologically-sound options. The first is to check with the pump manufacturer to see if they have a pump recycling program, such as the manufacturer Hygeia. If not, check to see if your county has an electronics recycling facility.

Important Breast Pump Features


We recommend the following key features in any pump you purchase.

Well fitting flange(s)


Flanges are the plastic pieces that you put over your breast when pumping. The pump's suction pulls the nipple into the flange. It is crucial for flanges to fit properly. Most breast pumps have flanges available in different sizes. You do not want the nipple to constantly be vigorously rubbing against the plastic as it may cause abrasions and lead to bleeding, pain, and even infection. If you have questions or concerns about fit, it is advisable to seek the help of a lactation consultant.

Dual-Phase Expression


Having a pump with 2 phases is important as each step aims to mirror what occurs during nursing with a baby. The first step is stimulation where baby takes short, shallow, frequent sucks to produce let down. The second phase is the expression where the milk comes in, and baby's sucks become longer and deeper.

Helpful Related Accessories


For pumping moms, pumping, transport, and storage accessories are necessary for smooth pumping sessions, easy transport of the goods, and efficient, safe storage of that liquid gold. With some pumps, you will need to purchase items separately like the tote bag we feature in our Spectra S1 review. However, others like the Medela Pump in Style Advanced are available with an additional suite of items. These include a tote bag, bottles, lids, breast milk storage bags, and a small insulated cooler with ice pack for storing breast milk until it finds a refrigerator or freezer.

Breast Pump Bag


For moms who need to pump outside of the home, having a good breast pump bag that both fits the essentials plus extras such as water, snack, keys, wallet, and cell phone, can be a huge perk. And, one that looks like a purse instead of the iconic pump totes is a real treat. Not all of the tote bags that were included with the pumps were big enough or stylish enough for these tasks.

Take a look at our review The Best Breast Pump Bag to find other available options than the one that may or may not be included with the purchase of your breast pump. You too can be Wonder Woman carrying everything you need while you are away from baby plus more in one bag.

Breast Milk Storage System


Whether you are pumping on-the-go or just at home, you'll need to consider purchasing a breast milk storage system such as bags or glass containers in which you can freeze your milk. For more on this topic, we invite you to read our article Best Practices for Handling Breast Milk.

Insulated Cooler & Freezing Pack: Size and Quality Matters


Cooler bag with ice pack and extra bottles  handy for a long day at work. This accessory is purchased separately from Spectra.
Insulated cooler bags are typically not a one size fits all solution either. They come in varying shapes and sizes holding anywhere from 3 to 8 bottles per bag. Total milk production, while mom is away from a baby, will need to be considered to find the right capacity. Also, you need to think about how long the cooler can maintain the breast milk at a healthy temperature. If you have a refrigerator the pumped milk can be placed in while you are at work leaving the freezer packs to do their duty to and from work, you are golden! Otherwise, the longer you are gone and the more milk you have, the bigger the insulated bag and more robust cooling packs need to be.

Bottles, Lids, and Milk Storage Bags


Before going back to work or for an outing where you will need to pump, it is a good idea to have down your preferred process. Basically, the longer you are gone, the more accessories you will need. Transferring milk into storage bags like Lansinoh Breast Milk Storage Bags while you're away can save space in the insulated cooler, but you need to make sure all is well-sealed and packaged into the cooler so as to prevent punctures in the bag.

Power Supply


If you depend upon an electric pump while out of the house, having the right accessories is important. Most electric pumps come equipped with an AC adapter to plug into an outlet. If you are pumping in the car or on the plane, a car adapter or battery pack can certainly come in handy. If you need battery power for a long time without an outlet, a rechargeable battery pack is necessary; only some pumps offer this feature so make sure to check.

We invite you to look at our breast pump ratings where we have a list of all we tested with included or available accessories. We also did dry test runs to find out how long batteries lasted. Full breasts and a dead battery just don't mix, so we recommend having your system down pat.
This pump can run on a battery pack  shown here  for those times when there is no outlet available.  We loved this feature!
This pump can run on a battery pack, shown here, for those times when there is no outlet available. We loved this feature!

Buying the Best Breast Pump


There are many different breast pumps on the market, each typically with their strengths and weaknesses. It honestly comes down to finding the best fit for your lifestyle, your milk production, your baby's needs, and your budget. Our Best Breast Pump Review should guide you to finding the right one for you.

In summary, here are the Award Winners:
  • Editors' Choice Spectra S1: $349. A single-user, double electric pump with hospital grade strength and a closed system. For its power and perks, it is available at a budget-friendly List price compared to prohibitively expensive multi-user, hospital grade pumps like the Medela Symphony which for moms who need a very powerful pump usually rent.
  • Best Value Medela Pump In Style Advanced $270. A single-user, double electric pump with an open system.
  • Top Pick Medela Harmony Manual: $41. A great companion to an electric pump for occasional use on an overnight or quick outing.

Above all, we wish every parent a stress-free and nurturing feeding experience with their baby.

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Dr. Juliet Spurrier is founder and Mom-in-Chief at BabyGearLab
Juliet Spurrier, MD
About the Author
Dr. Juliet Baciocco Spurrier is a board certified pediatrician, mother of two, and founder of BabyGearLab. Juliet earned her Bachelor of Arts degrees in Anthropology and Italian Literature from the University of California at Berkeley and her Medical degree from Georgetown University School of Medicine in Washington DC. She completed her pediatric residency at the Doernbecher Children's Hospital at Oregon Health & Science University in Portland, OR, and subsequently practiced pediatrics in both the Pacific Northwest and Silicon Valley. Juliet serves as Mom-in-Chief at BabyGearLab, where she oversees all baby product review activity, assuring that each review delivers on our commitment to quality.


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