What kind of pump should you buy?

It seems like these days the breast pump has joined the ranks of baby registry basics: every new mother assumes that she needs one. Like most spaces where breastfeeding and consumerism meet, there are good and bad aspects to this.

The fact that it's automatic is a big YAY!: it means that breast milk is what mothers assume their babies will drink. But breast milk doesn't equal breastfeeding - and there are important benefits to breastfeeding that breast milk from a bottle can't replicate. One of the main ones is the ease of preparation and clean up.

Pumping has a place for mothers who have to be separated from their nurslings for longer periods. It also has a place for mothers for whom latching has proved challenging and nursing supplementers too cumbersome. And for some families, the typical suggestions on how to cope with night-waking and high-needs babies aren't practical or sufficient. In these cases where a mother is maintaining a full supply, a heavy-duty double pump is in order - and that's not a worthy 'just in case' expense (renting a hospital grade is the better option most of the time anyway).

I remember stinging at a speech that Jack Newman gave a number of years ago where he scoffed about the "silly contraptions" manufacturers were coming out with for hands-free pumping. Clearly, I thought, he's never had to pump every three hours around the clock for a baby in the NICU - hands-free pumping meant a lot to me. Not that I had proper hands-free set-up, but I got fairly good at balancing the bottles on my knees while I read trashy magazines to distract myself from the anguish in my heart.

But like all things commercial, what would have been helpful to me when pumping was a necessity has the potential to overreach. Most women who are planning to breastfeed have no reason at all to expect that they'll need a pump in the first few months of their baby's life. Unless they are planning on returning to work within the first month or so, pumping right away has very little benefit at a time when the focus should be establishing a balanced milk supply and good breastfeeding relationship. Stashes can be built, but not at the expense of those early moments.

For mothers who are able to take humane maternity leaves, pumping is even less important. Certainly, for those mothers, an electric pump is probably overkill and even a manual pump will fail to encourage that most basic skill that every lactating woman should have - manual expression. This is so important that I am stunned how few women are taught it, much less properly.

So much as I stung at his cavalier attitude, Dr. Newman had gotten a whiff of the direction in which things were going. Medela, previously one of the very few WHO-compliant gear companies out there, last year decided to take a different step and begin actively marketing bottles and artificial nipples directly to consumers. In the grand scheme, they're certainly no Nestle and they make quality products that have saved and prolonged many breastfeeding relationships.

But so few women are getting good information about breastfeeding - I mean really good information about the practicalities of the day-to-day, not just "Breast is best" - that these kinds of products flooding the market and making it on must-have lists really does have the potential to create a whole new set of breastfeeding problems. Oversupply from over pumping, nipple confusion/flow preference, plugged ducts and mastitis from poor pumping practice (IE: balancing the bottles on your knees can create uneven pressure that leads to plugged ducts) and ultimately breastfeeding ending earlier than nature intended. Maybe it ends earlier because the problems become acute and force the hands of the nursing pair or maybe it's simply because the connection in breastfeeding that evolves between mom and baby is interrupted and there comes a day when "breast is best" just isn't enough.

So, don't be surprised next time you ask "Which pump should I buy? (or "buy for her")" that my answer is no pump at all.