what store to buy a breast pump federal way
Am J Public Health. 2011 August; 101(viii): 1356–1359.
The Quiet Revolution: Breastfeeding Transformed With the Employ of Breast Pumps
Accepted January 31, 2011.
Abstract
A placidity revolution has been taking identify in the feeding of US infants in the grade of women using electric breast pumps. This revolution in milk expression may exist a boon for both mothers and infants if more infants are fed man milk or if they receive homo milk for a longer flow.
Milk expression may besides be problematic for mothers, and it may be specially problematic for infants if they are fed too much, fed milk of an inappropriate composition, or fed milk that is contaminated.
Every bit a upshot, the time has come to determine the prevalence of exclusive and periodic breast milk expression and the consequences of these behaviors for the health of mothers and their infants.
Unbeknownst to most health professionals, a revolution is taking place in the way Us infants are fed man milk. The recent development of efficient and constructive double electric breast pumps has made information technology possible for many women to express their milk. In the 2005–2007 Infant Feeding Practices Study Two (IFPS Ii), 85% of breastfeeding mothers of infants anile one.5 to 4.5 months had successfully expressed milk at some fourth dimension since their infant was born.1 A loftier proportion of these women used a breast pump to limited their milk regularly and over an extended period.1 In addition, 5.half dozen% of the mothers of these immature infants never fed them at the breast; they fed them expressed milk exclusively. We believe that the possible benefits or harms resulting from this do merit conscientious report and improved national data collection. We identify these research priorities and suggest means to better collection of relevant data.
Women accept been expressing their milk to feed their infants since at least the 1500s,2 and they have been using breast pumps to assist them with this for nigh two centuries.3,4 Until recently, most pumps on the marketplace were manual, inexpensive, and often ineffective. Every bit a result, they were frustrating to use, and few women used them for extended periods. Recent advances in pump blueprint and effectiveness have allowed women to extract their milk rapidly (in about 15 minutes using a double pump) and to continue to limited their milk for weeks or months.1,5 By necessity, infants are routinely fed expressed milk in cases of preterm birthsix and multiple gestation.7 Women likewise express milk when separated from the babe considering of employment.8–ten Even without barriers to straight latching their infant to the breast, women today frequently limited their milk1 and may even employ breast pumps while doing other things, such as driving (Figure 1).
Women use pumps and store milk under a variety of conditions, such as (a) while driving, (b) in unsanitary conditions, and (c) in a variety of containers.
Lactating women who choose to pump differ systematically from those who practice non. In the IFPS II, women who expressed their milk had more pedagogy and a college household income than did those who did not express their milk. In add-on, a higher proportion of women who expressed their milk were employed, did non participate in the federal Special Supplemental Nutrition Program for Women, Infants, and Children, and had not breastfed previously, compared with women who did non express their milk.1 At present, the lay literature (e.g., mag articles, Internet postings) remains a major source of information about maternal beliefs related to milk expression, and some of these behaviors are of public health concern.
Women choose to limited their milk with a pump for a variety of reasons. In the IFPS II, the power to have someone else feed the babe was the predominant reason given for expressing milk.1 Milk expression has been an important strategy that women have used to combine breastfeeding with employment and utilise of child care.9 As suggested in Internet postings, some women really prefer expressing their milk to feeding their infants at the breast.11–13 Qualitative research is now needed to develop a more nuanced understanding of women's reasons for expressing their milk with a pump and their strategies for managing the integration of at-the-breast feeding with extended use of improved pumps.
POSSIBLE BENEFITS AND HARMS TO MOTHERS
With the improved electrical pumps, women are able to express every bit much milk as their infants would remove in a comparable menstruation of at-the-breast feeding.14 Thus, it is possible that this tranquility revolution in milk expression could benefit mothers. To the extent that the longer catamenia of feeding infants human milk documented in the IFPS II5 and suggested by the results of other studies15–xviii represents a net increase in milk production, this would create greater caloric expenditure for mothers that, like boosted breastfeeding, could assist them in reducing postpartum weight.nineteen Equally suggested in recent Internet postings, women may explicitly use milk expression as a weight-loss strategy regardless of whether they actually feed the expressed milk to their infants.20 Nosotros do not know, nonetheless, whether milk expression really leads to reduced postpartum weight or whether a longer menses of expressing milk has the other benefits for maternal well-being (eastward.g., bonding with the babe) and health (e.g., extending the period of postpartum amenorrhea or reducing the risk of premenopausal breast cancer, ovarian cancer, type two diabetes, myocardial infarction, or metabolic syndrome)21 that are associated with feeding the baby at the breast. These possible outcomes of milk expression should be studied.
Milk expression can as well be problematic for the mother. Proper utilize of an electric pump requires instruction and fitting of the breast shield. Improper apply of an electric pump can lead to mastitis, trauma, and nipple wounds.xviii,22 Some women increase their milk supply too much by chest expression with a pump, which results in pain from overstretching of the breast. How ofttimes this occurs with daily use of a pump has not yet been documented well and warrants further study.
POSSIBLE BENEFITS AND HARMS TO INFANTS
Women's enthusiasm for using these better pumps may be a positive outcome for infants if information technology means that infants receive more human milk than they would if their mothers did non use a pump. This consequence is suggested in the Internet postings of women who had such difficulty with breastfeeding that they would have fed formula but were instead able to give their infants their milk with the help of a chest pump.23 Women may choose to pump because they perceive that it volition permit them to feed their infants their milk for a longer period.18 Too, women's enthusiasm for pumping and their success in producing more milk than their own infants need may lead them to donate their backlog milk to a milk bank, where it could do good infants who might non otherwise accept access to the many positive attributes of human milk. Despite these possibilities, it remains unknown whether infants whose mothers pump their milk actually receive more human milk than they would if their mothers had not called to pump their milk. This question should be evaluated carefully.
Conversely, exchange of milk expression for feeding the baby at the breast may be problematic for infants for several reasons. The most serious of these chronicle to the composition of expressed milk and the way it is fed to the baby. For example, expressed milk may become contaminated in the process of transferring it to the infant,24 or the way it is stored may compromise its nutritional and anti-infective benefits. Nosotros discuss these possibilities in turn.
Milk expressed with a pump makes contact with nipple shields and valves during expression, and all expressed milk makes contact with a storage container or a feeding vessel before it is fed to the baby. Each of these items is a potential source of contagion if women pump in unsanitary conditions or if the pump and pump parts are not kept scrupulously clean22,25 (Figure 1). Some inquiry has shown that bacterial counts are higher in milk expressed with a pump than in milk expressed by hand.25,26 Women put their milk in a broad diverseness of containers (Figure 1), some of which are unsuitable for this use and can lead to the leaching of undesirable substances from the container into the milk or the degradation of key milk components during storage.27 Glass is the container to the lowest degree destructive of milk components,28,29 although women may use it infrequently. Research is needed to document the ways women handle and store their expressed milk earlier it is fed to their infants and how its composition changes during this process.
Women often shop their milk in the refrigerator and various kinds of freezers for short or long periods.xxx This practice may lead to bacterial growth or deposition of milk components. Information technology has long been known that when breast milk is stored at refrigeration temperatures, its ascorbic acrid concentration is reduced,31 equally is its overall antioxidant activity.32 When breast milk is stored at temperatures mutual in home freezers, lipids are hydrolyzed,33 immunological cells are lyzed,28 and antioxidant activity is reduced,32 but antimicrobial proteins are unaffected.34 Moreover, microwave thawing of frozen milk, which mothers practice, causes a marked decrease in anti-infective factors in milk.35 Every bit a result, expressed milk may non deliver the same nutritional and anti-infective benefits of milk obtained at the breast. The consequences of these differences for babe health are unknown and warrant investigation.27
Expressed milk is most oft fed to infants from bottles, and it is likely that caregivers treat human milk in a bottle the aforementioned way that they treat infant formula, that is, to encourage infants to finish the bottle. The IFPS 2 provides recent evidence to support this assertion; Li et al.36 constitute that infants fed expressed milk in a bottle early on in infancy were more likely to empty the bottle later in infancy than were infants who had been fed merely at the breast. This effect did not depend on whether human milk or infant formula was in the canteen. More enquiry is needed to ascertain whether infants fed expressed milk are, on the whole, fed differently and thus grow differently37 from those fed milk at the breast.
A concluding business concern for infant health is clinical and comes from the management of milk expression relative to at-the-breast feeding. Milk changes composition over the course of a single feeding38 and with infant age.39,40 This finding is besides true of expressed milk; its fat concentration increases with babe age.41 Information technology is not uncommon for mothers to feed their infants at the breast and then express their remaining milk with a pump. Thus, they feed their infants predominantly fore milk (which is loftier in carbohydrates) at the chest, and they store hind milk (which is high in fatty) to feed to their infants later. Consequently, these infants sometimes develop diarrhea and fail to thrive, a outcome that is analogous to the situation that occurs when infants are overfed at the breast.42 The frequency of this occurrence has non notwithstanding been documented and warrants farther study.
Data NEEDS
Nosotros are just kickoff to learn the extent to which US women express their milk with pumps. Our source of nationally representative data on breastfeeding, the National Immunization Survey,43 is adequate to determine how long infants receive human milk; unfortunately, even so, information technology does not discriminate between feedings obtained at the chest or given as expressed milk. Every bit a result, we do not know—and cannot determine past using routinely collected, nationally representative data—the extent to which women are feeding their infants expressed milk. This situation will only change if the National Immunization Survey is modified, which has been recommended for other reasons.44 At a minimum, feeding at the breast should be distinguished from feeding expressed milk, and the durations of each practice should exist ascertained.
Women who have expressed more milk than their infants need may donate it to milk banks, where it will be pasteurized before utilize. They may also requite their untreated milk to family unit members, friends, or strangers on Internet donation sites,45,46 or they may even sell it on the Internet.47 To date, no information is available to describe how common these behaviors are, but they are certainly a cause for concern, as untreated milk can transmit disease. Thus, it is essential to investigate how women dispose of their unneeded expressed milk.
To characterize women'due south behavior related to milk expression, it may exist necessary to develop a new vocabulary for breastfeeding so as to distinguish milk extracted from the breast by the baby from that extracted by a pump for feeding to the infant at a later time. In a previous study, we used a fix of possible culling terms to analyze data from the IFPS Iiv and suggested improved questions for use in research studies.48 In particular, we suggested that descriptive studies of breast milk feeding rates should include questions that (one) split up the mother'due south milk extraction from the child's milk consumption, (ii) distinguish betwixt milk fed at the breast and milk hand-expressed or pumped, and (3) tape the frequency of mothers feeding another mother's milk to their own infants.
Enquiry NEEDS
Nationally representative descriptive data is needed on who is expressing their milk, how long they are expressing, and how expression of breast milk is both distinct from and intertwined with feeding infants at the breast. In addition, research is needed to document the consequences—expert and bad—of milk expression as currently practiced for the wellness of infants and their mothers. This must involve developing a solid agreement of (i) women'due south motivations for expressing milk, (ii) how milk expression affects women's health, (3) how milk expression relates to the overall pattern of babe feeding, and (4) the nutritional value, immunological value, and safety of expressed milk as information technology is fed to infants.
CHALLENGES AND CONCLUSIONS
The advent of electrical double breast pumps raises many other problems that challenge public health professionals in their back up for breastfeeding. Will separating the dyadic aspects of at-the-breast feeding from the feeding of human milk erode societal support for breastfeeding, which is already low in the United states? Is pumping such a burdensome addition to women's already complex lives that they will end trying to feed their infants at the breast, equally seems to be happening amid the subgroup of women who are feeding their infants only pumped milk? Does the availability of these constructive, efficient pumps make it more than difficult to gather the requisite support for legislation to provide United states of america mothers with paid motherhood leave?
This tranquillity revolution in milk expression may be a boon for both mothers and infants if more than infants are fed human being milk or if they receive it for a longer catamenia. Milk expression may also be problematic for mothers, and it may exist particularly problematic for infants if they are fed too much, fed milk of an inappropriate composition, or fed milk that is contaminated. Congress recently enacted the Patient Protection and Affordable Intendance Human activity, which requires employers with fifty or more employees to provide "reasonable break fourth dimension" for mothers of infants to express their milk.49 This evolution adds urgency to the importance of determining the prevalence of exclusive and periodic milk expression and the consequences of these behaviors for the health of mothers and their infants.
Acknowledgments
K. G. Rasmussen was supported by the Us Department of Agronomics (grant Hatch 399307), and South. R. Geraghty was supported by the National Institutes of Health (grant K23 ES014691).
Human Participant Protection
Drove of photographs of women pumping milk was approved by the institutional review board of the Cincinnati Children's Hospital Medical Heart.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134520/
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