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Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology

Abstract

The majority of new mothers in the United States use breast pumps in the first 4 months postbirth in order to achieve their personal human milk feeding goals. Although these mothers seek guidance from health-care professionals with respect to the type and use of breast pumps, there are few evidence-based guidelines to guide this professional advice. This paper reviews the evidence to facilitate professional individualization of breast pump recommendations using three categories of literature: the infant as the gold standard to which the pump is compared; the degree of maternal breast pump dependency (for example, the extent to which the breast pump replaces the infant for milk removal and mammary gland stimulation); and the stage of lactation for which the pump replaces the infant. This review can also serve to inform public and private payers with respect to individualizing breast pump type to mother–infant dyad characteristics.

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References

  1. Labiner-Wolfe J, Fein SB, Shealy KR, Wang C . Prevalence of breast milk expression and associated factors. Pediatrics 2008; 122 (Suppl 2): S63–S68.

    Article  PubMed  Google Scholar 

  2. Flaherman VJ, Lee HC . ‘Breastfeeding’ by feeding expressed mother's milk. Pediatr Clin North Am 2013; 60 (1): 227–246.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Becker GE, Cooney F, Smith HA . Methods of milk expression for lactating women. Cochrane Database Syst Rev 2011 Dec 7;(12):CD006170.

  4. Kent JC, Mitoulas LR, Cregan MD, Geddes DT, Larsson M, Doherty DA et al. Importance of vacuum for breastmilk expression. Breastfeed Med 2008; 3 (1): 11–19.

    Article  PubMed  Google Scholar 

  5. Kent JC . How breastfeeding works. J Midwifery Womens Health 2007; 52 (6): 564–570.

    Article  PubMed  Google Scholar 

  6. Kent JC, Ramsay DT, Doherty D, Larsson M, Hartmann PE . Response of breasts to different stimulation patterns of an electric breast pump. J Hum Lact 2003; 19 (2): 179–186.

    Article  PubMed  Google Scholar 

  7. Daly SE, Kent JC, Owens RA, Hartmann PE . Frequency and degree of milk removal and the short-term control of human milk synthesis. Exp Physiol 1996; 81 (5): 861–875.

    Article  CAS  PubMed  Google Scholar 

  8. Meier PP, Engstrom JL, Janes JE, Jegier BJ, Loera F . Breast pump suction patterns that mimic the human infant during breastfeeding: greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol 2012; 32 (2): 103–110.

    Article  CAS  PubMed  Google Scholar 

  9. Wolff PH . Sucking patterns of infant mammals. Brain Behav Evol 1968; 1 (4): 354–367.

    Article  Google Scholar 

  10. Wolff PH . The serial organization of sucking in the young infant. Pediatrics 1968; 42 (6): 943–956.

    CAS  PubMed  Google Scholar 

  11. Neville MC . Anatomy and physiology of lactation. Pediatr Clin North Am 2001; 48 (1): 13–34.

    Article  CAS  PubMed  Google Scholar 

  12. Mitoulas LR, Ramsay DT, Kent JC, Larsson M, Hartmann PE . Identification of factors affecting breast pump efficacy. Adv Exp Med Biol 2004; 554: 325–327.

    Article  CAS  PubMed  Google Scholar 

  13. Mizuno K, Ueda A . Changes in sucking performance from nonnutritive sucking to nutritive sucking during breast- and bottle-feeding. Pediatr Res 2006; 59 (5): 728–731.

    Article  PubMed  Google Scholar 

  14. Bowen-Jones A, Thompson C, Drewett RF . Milk flow and sucking rates during breast-feeding. Dev Med Child Neurol 1982; 24 (5): 626–633.

    CAS  PubMed  Google Scholar 

  15. Drewett RF, Woolridge M . Sucking patterns of human babies on the breast. Early Hum Dev 1979; 3 (4): 315–321.

    Article  CAS  PubMed  Google Scholar 

  16. Elad D, Kozlovsky P, Blum O, Laine AF, Po MJ, Botzer E et al. Biomechanics of milk extraction during breast-feeding. Proc Natl Acad Sci USA 2014; 111 (14): 5230–5235.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Meier PP . Suck-breathe patterning during bottle and breast feeding for preterm infants. In: David TJ (ed). Major Controversies in Infant Nutrition. International Congress and Symposium Series 215. Royal Society of Medicine Press: London, England, 1996; 9–20.

  18. Ramsay DT, Hartmann PE . Milk removal from the breast. Breastfeed Rev 2005; 13 (1): 5–7.

    PubMed  Google Scholar 

  19. Mathew OP, Bhatia J . Sucking and breathing patterns during breast- and bottle-feeding in term neonates. Effects of nutrient delivery and composition. Am J Dis Child 1989; 143 (5): 588–592.

    Article  CAS  PubMed  Google Scholar 

  20. Geddes DT, Chadwick LM, Kent JC, Garbin CP, Hartmann PE . Ultrasound imaging of infant swallowing during breast-feeding. Dysphagia 2010; 25 (3): 183–191.

    Article  PubMed  Google Scholar 

  21. Ramsay DT, Kent JC, Hartmann RA, Hartmann PE . Anatomy of the lactating human breast redefined with ultrasound imaging. J Anat 2005; 206 (6): 525–534.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ramsay DT, Mitoulas LR, Kent JC, Larsson M, Hartmann PE . The use of ultrasound to characterize milk ejection in women using an electric breast pump. J Hum Lact 2005; 21 (4): 421–428.

    Article  PubMed  Google Scholar 

  23. Geddes DT, Kent JC, Mitoulas LR, Hartmann PE . Tongue movement and intra-oral vacuum in breastfeeding infants. Early Hum Dev 2008; 84 (7): 471–477.

    Article  PubMed  Google Scholar 

  24. Zinaman MJ, Hughes V, Queenan JT, Labbok MH, Albertson B . Acute prolactin and oxytocin responses and milk yield to infant suckling and artificial methods of expression in lactating women. Pediatrics 1992; 89 (3): 437–440.

    CAS  PubMed  Google Scholar 

  25. Lussier MM, Brownell EA, Proulx TA, Bielecki DM, Marinelli KA, Bellini SL et al. Daily breastmilk volume in mothers of very low birth weight neonates: a repeated-measures randomized trial of hand expression versus electric breast pump expression. Breastfeed Med 2015; 10: 312–317.

    Article  PubMed  Google Scholar 

  26. Paul VK, Singh M, Deorari AK, Pacheco J, Taneja U . Manual and pump methods of expression of breast milk. Indian J Pediatr 1996; 63 (1): 87–92.

    Article  CAS  PubMed  Google Scholar 

  27. Jones E, Dimmock PW, Spencer SA . A randomised controlled trial to compare methods of milk expression after preterm delivery. Arch Dis Child Fetal Neonatal Ed 2001; 85 (2): F91–F95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Slusher T, Slusher IL, Biomdo M, Bode-Thomas F, Curtis BA, Meier P . Electric breast pump use increases maternal milk volume in African nurseries. J Trop Pediatr 2007; 53 (2): 125–130.

    Article  PubMed  Google Scholar 

  29. Green D, Moye L, Schreiner RL, Lemons JA . The relative efficacy of four methods of human milk expression. Early Hum Dev 1982; 6 (2): 153–159.

    Article  CAS  PubMed  Google Scholar 

  30. Flaherman VJ, Gay B, Scott C, Avins A, Lee KA, Newman TB . Randomised trial comparing hand expression with breast pumping for mothers of term newborns feeding poorly. Arch Dis Child Fetal Neonatal Ed 2012; 97 (1): F18–F23.

    Article  PubMed  Google Scholar 

  31. Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD . Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 2009; 29 (11): 757–764.

    Article  CAS  PubMed  Google Scholar 

  32. Hopkinson J, Heird W . Maternal response to two electric breast pumps. Breastfeed Med 2009; 4 (1): 17–23.

    Article  PubMed  Google Scholar 

  33. Fewtrell MS, Lucas P, Collier S, Singhal A, Ahluwalia JS, Lucas A . Randomized trial comparing the efficacy of a novel manual breast pump with a standard electric breast pump in mothers who delivered preterm infants. Pediatrics 2001; 107 (6): 1291–1297.

    Article  CAS  PubMed  Google Scholar 

  34. Ramsay DT, Mitoulas LR, Kent JC, Cregan MD, Doherty DA, Larsson M et al. Milk flow rates can be used to identify and investigate milk ejection in women expressing breast milk using an electric breast pump. Breastfeed Med 2006; 1 (1): 14–23.

    Article  PubMed  Google Scholar 

  35. Mitoulas LR, Lai CT, Gurrin LC, Larsson M, Hartmann PE . Effect of vacuum profile on breast milk expression using an electric breast pump. J Hum Lact 2002; 18 (4): 353–360.

    Article  PubMed  Google Scholar 

  36. Mitoulas LR, Lai CT, Gurrin LC, Larsson M, Hartmann PE . Efficacy of breast milk expression using an electric breast pump. J Hum Lact 2002; 18 (4): 344–352.

    Article  PubMed  Google Scholar 

  37. Prime DK, Geddes DT, Hepworth AR, Trengove NJ, Hartmann PE . Comparison of the patterns of milk ejection during repeated breast expression sessions in women. Breastfeed Med 2011; 6 (4): 183–190.

    Article  PubMed  Google Scholar 

  38. Meier PP, Engstrom JL, Hurst NM, Ackerman B, Allen M, Motykowski JE et al. A comparison of the efficiency, efficacy, comfort, and convenience of two hospital-grade electric breast pumps for mothers of very low birthweight infants. Breastfeed Med 2008; 3 (3): 141–150.

    Article  PubMed  Google Scholar 

  39. Post ED, Stam G, Tromp E . Milk production after preterm, late preterm and term delivery; effects of different breast pump suction patterns. J Perinatol 2015; 36 (1): 47–51.

    Article  PubMed  Google Scholar 

  40. Meier PP, Engstrom JL . Evidence-based practices to promote exclusive feeding of human milk in very low-birthweight infants. Neoreviews 2007; 8 (11): e467–e477.

    Article  Google Scholar 

  41. Kent JC, Geddes DT, Hepworth AR, Hartmann PE . Effect of warm breastshields on breast milk pumping. J Hum Lact 2011; 27 (4): 331–338.

    Article  PubMed  Google Scholar 

  42. Kent JC, Hepworth AR, Sherriff JL, Cox DB, Mitoulas LR, Hartmann PE . Longitudinal changes in breastfeeding patterns from 1 to 6 months of lactation. Breastfeed Med 2013; 8 (4): 401–407.

    Article  PubMed  Google Scholar 

  43. Smith MM, Durkin M, Hinton VJ, Bellinger D, Kuhn L . Initiation of breastfeeding among mothers of very low birth weight infants. Pediatrics 2003; 111 (6): 1337–1342.

    Article  PubMed  Google Scholar 

  44. Larkin T, Kiehn T, Murphy PK, Uhryniak J . Examining the use and outcomes of a new hospital-grade breast pump in exclusively pumping NICU mothers. Adv Neonatal Care 2013; 13 (1): 75–82.

    Article  PubMed  Google Scholar 

  45. Alekseev NP, Ilyin VI, Yaroslavski VK, Gaidukov SN, Tikhonova TK, Specivcev YA et al. Compression stimuli increase the efficacy of breast pump function. Eur J Obstet Gynecol Reprod Biol 1998; 77 (2): 131–139.

    Article  CAS  PubMed  Google Scholar 

  46. Howie PW, Houston MJ, Cook A, Smart L, McArdle T, McNeilly AS . How long should a breast feed last? Early Hum Dev 1981; 5 (1): 71–77.

    Article  CAS  PubMed  Google Scholar 

  47. Hill PD, Aldag JC, Chatterton RT . The effect of sequential and simultaneous breast pumping on milk volume and prolactin levels: a pilot study. J Hum Lact 1996; 12 (3): 193–199.

    Article  CAS  PubMed  Google Scholar 

  48. Meier P, Patel AL, Wright K, Engstrom JL . Management of breastfeeding during and after the maternity hospitalization for late preterm infants. Clin Perinatol 2013; 40 (4): 689–705.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Felice JP, Rasmussen KM . Breasts pumps and bottles, and unanswered questions. Breastfeed Med 2015; 10: 412–415.

    Article  PubMed  Google Scholar 

  50. Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns N . Improving the use of human milk during and after the NICU stay. Clin Perinatol 2010; 37 (1): 217–245.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Meier PP, Patel AL, Bigger HR, Rossman B, Engstrom JL . Supporting breastfeeding in the neonatal intensive care unit: Rush mother's milk club as a case study of evidence-based care. Pediatr Clin North Am 2013; 60 (1): 209–226.

    Article  PubMed  Google Scholar 

  52. Neville MC, Morton J . Physiology and endocrine changes underlying human lactogenesis II. J Nutr 2001; 131 (11): 3005S–3008S.

    Article  CAS  PubMed  Google Scholar 

  53. Pang WW, Hartmann PE . Initiation of human lactation: secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia 2007; 12 (4): 211–221.

    Article  PubMed  Google Scholar 

  54. Nguyen DA, Parlow AF, Neville MC . Hormonal regulation of tight junction closure in the mouse mammary epithelium during the transition from pregnancy to lactation. J Endocrinol 2001; 170 (2): 347–356.

    Article  CAS  PubMed  Google Scholar 

  55. Kuhn NJ . Progesterone withdrawal as the lactogenic trigger in the rat. 1969. J Mammary Gland Biol Neoplasia 2009; 14 (3): 327–342.

    Article  CAS  PubMed  Google Scholar 

  56. Hartmann PE, Trevethan P, Shelton JN . Progesterone and oestrogen and the initiation of lactation in ewes. J Endocrinol 1973; 59 (2): 249–259.

    Article  CAS  PubMed  Google Scholar 

  57. Neville MC, Morton J, Umemura S . Lactogenesis. the transition from pregnancy to lactation. Pediatr Clin North Am 2001; 48 (1): 35–52.

    Article  CAS  PubMed  Google Scholar 

  58. Nommsen-Rivers LA, Chantry CJ, Peerson JM, Cohen RJ, Dewey KG . Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding. Am J Clin Nutr 2010; 92 (3): 574–584.

    Article  CAS  PubMed  Google Scholar 

  59. Santoro W Jr, Martinez FE, Ricco RG, Jorge SM . Colostrum ingested during the first day of life by exclusively breastfed healthy newborn infants. J Pediatr 2010; 156 (1): 29–32.

    Article  PubMed  Google Scholar 

  60. Neville M, Keller R, Seacat J, Lutes V, Neifert M, Casey C et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 1988; 48: 1375–1386.

    Article  CAS  PubMed  Google Scholar 

  61. Hurst NM . Recognizing and treating delayed or failed lactogenesis II. J Midwifery Womens Health 2007; 52 (6): 588–594.

    Article  PubMed  Google Scholar 

  62. Nommsen-Rivers LA, Dolan LM, Huang B . Timing of stage II lactogenesis is predicted by antenatal metabolic health in a cohort of primiparas. Breastfeed Med 2012; 7 (1): 43–49.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Rasmussen KM . Association of maternal obesity before conception with poor lactation performance. Annu Rev Nutr 2007; 27: 103–121.

    Article  CAS  PubMed  Google Scholar 

  64. Parker LA, Sullivan S, Krueger C, Mueller M . Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med 2015; 10 (2): 84–91.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Parker LA, Sullivan S, Krueger C, Kelechi T, Mueller M . Effect of early breast milk expression on milk volume and timing of lactogenesis stage II among mothers of very low birth weight infants: a pilot study. J Perinatol 2012; 32 (3): 205–209.

    Article  CAS  PubMed  Google Scholar 

  66. Hill PD, Aldag JC, Chatterton RT, Zinaman M . Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J Hum Lact 2005; 21 (1): 22–30.

    Article  PubMed  Google Scholar 

  67. Chapman Donna J, Perez-Escamilla R . Lactogenesis stage II: hormonal regulation, determinants and public health consequences. Recent Res Dev Nutr 2000; 3: 43–63.

    Google Scholar 

  68. Brownell E, Howard CR, Lawrence RA, Dozier AM . Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 2012; 161 (4): 608–614.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Knight CH, Peaker M, Wilde CJ . Local control of mammary development and function. Rev Reprod 1998; 3 (2): 104–112.

    Article  CAS  PubMed  Google Scholar 

  70. Daly SE, Hartmann PE . Infant demand and milk supply. Part 2: The short-term control of milk synthesis in lactating women. J Hum Lact 1995; 11 (1): 27–37.

    Article  CAS  PubMed  Google Scholar 

  71. Daly SE, Owens RA, Hartmann PE . The short-term synthesis and infant-regulated removal of milk in lactating women. Exp Physiol 1993; 78 (2): 209–220.

    Article  CAS  PubMed  Google Scholar 

  72. Battin DA, Marrs RP, Fleiss PM, Mishell DR Jr. . Effect of suckling on serum prolactin, luteinizing hormone, follicle-stimulating hormone, and estradiol during prolonged lactation. Obstet Gynecol 1985; 65 (6): 785–788.

    CAS  PubMed  Google Scholar 

  73. Hill PD, Chatterton RT Jr, Aldag JC . Serum prolactin in breastfeeding: state of the science. Biol Res Nurs 1999; 1 (1): 65–75.

    Article  CAS  PubMed  Google Scholar 

  74. Glasier A, McNeilly AS, Howie PW . The prolactin response to suckling. Clin Endocrinol (Oxf) 1984; 21 (2): 109–116.

    Article  CAS  Google Scholar 

  75. Howie PW, McNeilly AS, McArdle T, Smart L, Houston M . The relationship between suckling-induced prolactin response and lactogenesis. J Clin Endocrinol Metab 1980; 50 (4): 670–673.

    Article  CAS  PubMed  Google Scholar 

  76. Blatchford DR, Hendry KA, Wilde CJ . Autocrine regulation of protein secretion in mouse mammary epithelial cells. Biochem Biophys Res Commun 1998; 248 (3): 761–766.

    Article  CAS  PubMed  Google Scholar 

  77. Wilde CJ, Addey CV, Casey MJ, Blatchford DR, Peaker M . Feed-back inhibition of milk secretion: the effect of a fraction of goat milk on milk yield and composition. Q J Exp Physiol 1988; 73 (3): 391–397.

    Article  CAS  PubMed  Google Scholar 

  78. Wilde CJ, Blatchford DR, Knight CH, Peaker M . Metabolic adaptations in goat mammary tissue during long-term incomplete milking. J Dairy Res 1989; 56 (1): 7–15.

    Article  CAS  PubMed  Google Scholar 

  79. Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE . Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics 2006; 117 (3): e387–e395.

    Article  PubMed  Google Scholar 

  80. Lau C, Alagugurusamy R, Schanler RJ, Smith EO, Shulman RJ . Characterization of the developmental stages of sucking in preterm infants during bottle feeding. Acta Paediatr 2000; 89 (7): 846–852.

    Article  CAS  PubMed  Google Scholar 

  81. Martino K, Wagner M, Froh EB, Hanlon AL, Spatz DL . Postdischarge breastfeeding outcomes of infants with complex anomalies that require surgery. J Obstet Gynecol Neonatal Nurs 2015; 44 (3): 450–457.

    Article  PubMed  Google Scholar 

  82. Froh EB, Hallowell S, Spatz DL . The use of technologies to support human milk & breastfeeding. J Pediatr Nurs 2015; 30 (3): 521–523.

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was funded by NIH grants: NR010009 and NICHD R03HD081412.

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Correspondence to P P Meier.

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Meier, P., Patel, A., Hoban, R. et al. Which breast pump for which mother: an evidence-based approach to individualizing breast pump technology. J Perinatol 36, 493–499 (2016). https://doi.org/10.1038/jp.2016.14

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