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Subject: misc.kids FAQ on breastpumps, Part 1/2

This article was archived around: 23 May 2006 04:24:18 GMT

All FAQs in Directory: misc-kids/breastfeeding/breastpumps
All FAQs posted in: misc.kids.info
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Archive-name: misc-kids/breastfeeding/breastpumps/part1 Posting-Frequency: monthly Last-modified: 1995/03/01
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. ############################################################