Do I Need a Breast Pump?

When breastfeeding is going well and if you don’t plan on being parted from your baby, a breast pump is not an essential purchase. Sometimes it is helpful to remove breast milk from a breast, however a breast pump is not the only way as hand expressing can be very effective. This article looks at situations when a breast pump might be useful and answers frequently asked questions. It is a companion article to How to Increase Milk Supply When Pumping.

Do I need a pump if I am exclusively breastfeeding?

Most mothers won’t need a breast pump if they are exclusively breastfeeding. If situations arise when it might be useful to remove additional breast milk manually (see below) then a mother can hand express or a pump can be purchased as and when needed.

What is hand expressing?

A breast pump is not the only way to remove milk from a breast. Breast milk can be removed by using ones fingers to rhythmically compress the breast behind the nipple. For much more information including useful videos see Hand Expressing Breast Milk. Hand expressing techniques are very useful for removing milk from an engorged breast to resume comfort levels, or for expressing enough milk for a feed if a mother is due to be separated from her baby.

When might a breast pump be useful?

It can be helpful to express breast milk by pump in the following situations:

• If a baby is not able to breastfeed—removing breast milk from the breasts frequently will stimulate your milk supply and provide a supplement to keep your baby well fed until he is able to breastfeed. Pumping eight to ten times a day is often suggested as a useful guide if a newborn is not breastfeeding directly at the breast. Using a breast pump can be more efficient and less tiring than hand expression if milk needs to removed very regularly. Hiring a hospital grade pump for a month or two may be a good option if a pump is not needed long term.
• If a baby is not getting enough breast milk—pumping after breastfeeds can help to increase a milk supply by thoroughly draining the breasts and stimulating more milk production. As in the point above hand expressing could serve this purpose but for regular use a breast pump can be more efficient and less tiring on the hands.
• If breasts are engorged—pumping or hand expressing to remove enough breast milk from the breast to resume comfort levels will relieve engorgement and avoid blocked milk ducts or mastitis (inflammation of the breast).
• If you will be separated from your baby regularly or are returning to work you will need to pump enough breast milk to feed your baby while you are away from him. Pumping breast milk can be very effective when larger volumes are needed.
• If you have flat, inverted or dimpled nipples a breast pump can help to evert your nipples before a breastfeed which may make it easier for your baby to latch (attach to the breast) when he is learning to nurse.

What about expressing so my partner can help with night feeds?

Some mothers may be interested in expressing milk in advance for night feeds so they won’t have to get up at night to feed the baby and might get a full night’s sleep. However although this may work for some families occasionally, this could compromise a new mother’s milk supply. Babies expect to breastfeed during the night and your breasts expect to breastfeed too. One of the hormones of lactation, prolactin, is especially high at night. By sleeping all night instead of breastfeeding on demand, your breasts may become engorged with milk. Engorgement can be painful, will cause your milk production to slow down and can put you at risk of getting blocked ducts or mastitis. The chances are, you will wake at night anyway with uncomfortable, full breasts and need to pump to make yourself comfortable again. Waking to pump defeats the objective of a full nights sleep and, in most cases, you may as well breastfeed your baby while you’re awake. For more reading see Baby Waking Up at Night and Bed-Sharing With Baby.

Are there any disadvantages to using a breast pump?

• Cost. There are many different types of breast pump such as manual (hand operated), electric (single or double) or hospital grade (expensive multi-user pumps used in hospitals) and some can be very expensive to buy. Checking reviews and considering why you need a breast pump can help a mother choose one that is cost effective for her needs.
• Cleaning time. Pump parts will need to be cleaned very carefully which can be time consuming.
• Hygiene concerns over time. Unless the pump has a closed system and includes safeguards for several users such as hospital grade pumps, it is unhygienic to use second hand equipment. Doing so will usually invalidate a warranty. Infections can be associated with using a breast pump. Mould and pathogens have been found inside used breast pumps e.g. within the tubing. ¹
• Overstimulation causing oversupply. Too much unnecessary pumping can increase milk supply to problematic levels.
• Reducing milk supply. Exclusively pumping mothers may find their milk supply begins to drop over time due to the differences with direct breastfeeding however see Exclusively Pumping Breast Milk for further information.
• Nipple preference. Once breast milk has been removed from the breast it has to be fed back to baby. Feeding methods include cup, bottle, or by a feeding tube on a finger. Each has their own advantages and disadvantages. Some types of bottle have more potential to affect a baby’s latch at the breast than others (nipple confusion) or for baby to prefer a bottle over a breast (nipple preference). For more information to reduce nipple confusion see Best Bottle for a Breastfed Baby? and Tips to Bottle Feed a Breastfed Baby.
• Breakdowns. Pumps can break or may not work properly. The Womanly Art of Breastfeeding explains:

…consumer-grade pumps aren’t built to last much more than a year or so, the average length of time that a mother might be pumping for one baby. When they start to wear out, they don’t just suddenly stop working. The suction and cycling mechanisms veeerrry slowly break down, and eventually you realise you aren’t pumping as much milk and the suction doesn’t feel as strong (or is too strong). Consumer-grade pumps aren’t closed system like rental-grade pumps, so milk and moisture may have entered the mechanical parts, where bacteria, mould, and viruses can grow.

What is the best type of breast pump?

One type of breast pump isn’t necessarily better than another as different pumps suit different mothers and some mothers may even find hand expressing works better than pumping for them. Options include:

• Manual pump—works by manually squeezing a lever with the hand to draw milk from the breast by suction. Usually one of the cheapest types of pump.
• Silicone pump—a single piece silicone pump with no moving parts which works by suction generating a gentle vacuum pressure on the milk making tissue of one breast while you feed your baby on the opposite breast to create a let down. For more information see This Year’s Big Thing… which describes the Haakaa pump by Shel Banks.
• Single electric breast pump—an electric or battery operated pump that allows pumping each breast separately.
• Double electric breast pump—an electric or battery operated pump with two collection sets to allow pumping both breasts at the same time. Newcomers to the pump market in recent years include a range of hands free portable pumps with a rechargeable battery (brands include Elvie, Freemie or Willow) which can be slipped unobtrusively into a nursing bra.
• Hospital grade double electric breast pump—a pump that is suitable for more than one user and has a greater reliability and efficiency. Expensive to buy, these pumps can be hired from pump manufacturers or hospitals.

For specific brand recommendations there is a useful section on p 193/4 of Making More Milk The Breastfeeding Guide to Increasing Your Milk Production 2020 by Lisa Marasco and Diana West or visit their website at lowmilksupply.org for a summary of their favourite pumps and their individual features.

Our sister article How to Increase Milk Supply When Pumping has more tips for choosing a breast pump:

• Look for a pump with multiple settings for speed and suction to give you more comfort and control and to mimic a baby’s sucking pattern. Some breast pumps can generate unsafe vacuum levels or maintain a vacuum for too long. Pumping should not hurt and pumping with a suction that is too high can inhibit milk release (Mohrbacher, 2020 p 490)
• Consider whether you want a single pump or a double pump. A double pump allows you to pump both breasts simultaneously which can save time (see above).
• Look for a choice of flange size. The part of the pump that is held to the breast has various names with different pump manufacturers such as breast shield (Medela), breast shell (Ardo), funnel (Ameda) or flange. Look for a pump with different sized flanges because nipples and breasts are not all the same size and the right fit is important for your comfort levels (pumping should not hurt!)—see “Breast pump flange fit” below.
• Availability of replacement parts. Consider whether a battery back up option would be useful in addition to mains operated.
• Check reviews online from other women who have tried them before buying a pump.
• Hospital grade pumps may be available to borrow from your maternity hospital or for short-term hire from major pump manufacturers in your country e.g. contact Ardo, or Medela in the UK.
• Second hand pumps may not work efficiently and may have hygiene concerns.

Using a breast pump

If you do decide you need a breast pump and want tips to maximise the amount of milk expressed see How to Increase Milk Supply When Pumping for help with:

• How often to pump
• How long to pump in each session
• What sort of volume of milk to aim for
• How to choose and use a breast pump
• How to get the correct size flange for your nipple size.

Summary

There is no need for every pregnant woman who wants to breastfeed to buy a breast pump just in case they need one. In most cases when breastfeeding is going well you will not need to pump your breast milk. If you do need to express milk occasionally due to engorgement or because you need to leave some milk for your baby while you’re apart; hand expression can work very well. If you have a newborn baby who can’t breastfeed yet, hiring a hospital grade pump for a month or two may be all that is needed. While a breast pump can be very useful in a number of situations, mothers can decide whether they need one based on their own circumstances. For much more information on using a pump see How to Increase Milk Supply When Pumping.