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"The water content of breastmilk consumed by an exclusively breastfed baby meets the water requirements for infants and provides a considerable margin of safety. 2016; 127(2):e86-e92. Worries are a normal part of new motherhood, but you can make milk expression a much more pleasant experience by learning what to expect. Milk expression was achieved by a variety of methods which included hand-expression, manual pumps and electric pumps. [citation needed], A breast pump may be also used to address a range of challenges parents may encounter breast feeding, including difficulties latching, separation from an infant in intensive care, to feed an infant who cannot extract sufficient milk itself from the breast, to avoid passing medication through breast milk to the baby, or to relieve engorgement, a painful condition whereby the breasts are overfull. 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice. [8], A breast pump may also be used to stimulate lactation for women with a low milk supply or those who have not just given birth. Pumping may also be desirable to continue lactation and its associated hormones to aid in recovery from pregnancy even if the pumped milk is not used. MPTAC review. (2009). Long-term effects of breastfeeding: a systematic review. 11,135 to O.H. No. Your emotional state. Adv Neonatal Care. These pumps are more durable and powerful to support more frequent pumping of breast milk. Breast milk should never be microwaved as this can produce dangerous hot areas and may also destroy the milk's antibodies. MPTAC review. [citation needed], Manual breast pumps are operated by squeezing or pulling a handle in a repetitive fashion, allowing the user to directly control the pressure and frequency of milk expression. For information on how to keep your pump parts clean before and after use, visit How to Keep Your Breast Pump Kit Clean: The Essentials. Health Technol Assess. endstream If the nipple tunnel squeezes your nipple during pumping, this reduces your milk flow and you pump less milk. Body and Mind Resources for Teachers, U.S. Department of Health & Human Services. Empowering you with mother-to-mother support. "Breastmilk is 88 percent water. CPT Only American Medical Association. 2016; 387(10017):491-504. Position of the American Dietetic Association: promoting and supporting breastfeeding. Keeping the parts of your pump clean is very important. Johnston M, Landers S, Noble L, et al. While you may choose to pump exclusively, based on your preference, this is usually considered an exhaustive process for most mothers if you have the option to feed your baby directly from your breasts. References June 19, 2015. Fast-diaphragm pumps use a diaphragm that is acted on by a lever and can operate at thousands of cycles per minute. When services are Not Medically Necessary:For the procedure codes listed above when criteria are not met or for situations designated in the Clinical Indications section as not medically necessary. During these situations, the mother needs to extract breast milk in order to provide nutrients necessary for healthy growth and development. If you have Medicaid they pay for pumps too, you just have to ask how the insurance pays for them and what you need to do to get one. K112856. The authors produced a video showing the technique and states that this technique is good for both mothers of premature infants as well as mothers that return to work or pump for other purposes. Strategies to prevent obesity and other chronic diseases: the CDC guide to strategies to support breastfeeding mothers and babies. Evid Rep Technol Assess (Full Rep). Chung M, Raman G, Trikalinos T, et al. [9][10], In a 2012 policy statement, the American Academy of Pediatrics recommended feeding preterm infants human milk, finding "significant short- and long-term beneficial effects," including lower rates of necrotizing enterocolitis (NEC). That is rarely the case, especially the first few times you pump. 2015; (2):CD006170. A subtype of the open-collection system is the single-user suction source. Your breast storage capacity, This is the maximum amount of milk available in your breasts during the time of day when your breasts are at their fullest. If you pumped more milk for a previous child, you may be thinking back to a time when your milk production was already at its peak rather than during the early weeks while it was still building. Methods to promote optimal milk expression (such as early initiation of milk expression, relaxation music, hand expression, manual pumps and warming of the breasts) were As effective or more effective, than large electric pumps for some outcomes. The authors noted caution in interpretation of the results as the interventions and study methodologies varied across the studies. Thirty to sixty cycles per minute can be expected with better-quality electric breast pumps. No matter when you pump, you can pump on one side while nursing on the other to take advantage of the baby-induced let-down. A type of pump which is approved by the FDA for safe use by multiple users, where each individual utilizes their own collection kit (typically includes breast shields and tubing), is the electric, heavy-duty breast pump. CDC twenty four seven. James DC, Lessen R; American Dietetic Association. Mothers often assume that stronger pump suction yields more milk, but this is not true. 2016; 16(4):254. 54KZA~k!+f-qaG``6F!E}V~Wj V}pdEq~Ou !lY03\ pVi^|x>,n7cT n]qToIhVU7@ ; 4(p:zo_mPgDSGNn{zOSKc_ IJ{~1DSNF2pQ]{3B^nTvPkz96W SSC7@LW?Vb !37St-Bj=8Q[YZH xerNq cl0eh`64ccu @uN9{G}\qRo7o^d&r$%tc%f0lAF{z}#qa6T#4- Exclusively breastfeeding? Recommendations include use of a hospital-grade electric pump with a double collection kit to initiate lactation and establish an adequate milk supply. They tend to be noisy. First know it takes time and practice to train your body to respond to your pump like it does to your baby. Updated Discussion and References sections. [25], Open-collection systems can cause milk to overflow into the collection system tubing, and milk particles being drawn into the pump motor. MPTAC review. Many mothers discoverto their surprisethat when they compare their own pumping experience with the norm, theyre doing just fine. Most pump manufacturers, however, supply their pumps with only standard 24 and 27 mm flanges. Expressed breast milk is needed for times when the infant is unable to breastfeed due to medical (for example, confinement in an intensive care unit, prematurity, apnea, etc.) Piston pumps draw a piston through a cylinder to create suction. Some models of pumps have bacteria and overflow filters which prevent milk from entering the tubing.[25]. This may be done because the mother produces too much milk, or because the mother will be away from the baby too long without a way to store the milk, or because of concern over alcohol or some other sustance that the baby should not have. The U.S. Preventive Services Task Force (USPSTF, 2016) recommends interventions during pregnancy and after birth to promote and support the initiation and continuation of breastfeeding. When services may be Medically Necessary when criteria are met: Breast pump, electric (AC and/or DC), any type, Breast pump, hospital grade, electric (AC and/or DC), any type, Durable medical equipment, miscellaneous [when specified as a wireless or wearable breast pump]. K132220. Dont assume (as many do) that what you pump is a gauge of your milk production. American Journal of Clinical Nutrition, 83(4), 851-858. Your babys age. A good time to pump milk to store is usually thirty to sixty minutes after the first morning nursing. It can also be too large. Clinical UM guidelines are used when the plan performs utilization review for the subject. Most breast pumps direct the pumped milk into a container that can be used for storage and feeding. << /Filter /FlateDecode /S 84 /Length 118 >> endstream MPTAC review. Some electric pumps allow multi-user operation but recommend an accessory kit for each user to maintain cleanliness. Pump fit is not about breast size; its about nipple size. Available at: U.S. National Library of Medicine. 2008; 149(8):565-582. Rockville, MD: FDA. The expressed breast milk (EBM) may be stored and later fed to a baby by bottle. 2012; 129(3):e827-e841. This eliminates the work of pumping by hand or the need for finding an electrical outlet with privacy. A closed collection system has a barrier or diaphragm that separates the pump tubing from the horn. There are three main types of breast pumps: manual, battery-powered and electric pumps. Failure to thoroughly clean collection tubing may lead to mould growth within the tubing. Breastfeed Med. Thawing can be done by placing the frozen milk in the refrigerator the night before intended use, or by placing the milk in a bowl of warm water. Available at: Lucina-Melodi Advance Breast Pump. Breastfeeding and the use of human milk. It refers to how well your nipples fit into the pump opening or nipple tunnel that your nipple is pulled into during pumping. Clinical Preventive Services for Women: Closing the Gaps. Breast pumps may be used to increase or maintain a womans milk supply, relieve engorged breasts and plugged milk ducts, or pull out flat or inverted nipples so a nursing baby can latch-on to its mothers breast more easily (FDA, 2018). Egnell in 1956 established a 220 mmHg safe maximum for automatic cycling pumps; however, there have been reports of sensitive breasts and nipples at much lower pressures. In this design, the suction of the pump motor lifts the diaphragm to create a vacuum within the collection system to extract milk. 23 0 obj [18], Mechanically, a breast pump triggers the milk ejection response or "letdown". Pumps have also been designed that use venturi effects powered by a faucet or water stream, wall suction in hospitals, or oral suctioning. 2009; 109(11):1926-1942. An electric, heavy-duty, hospital-grade breast pump is recommended for mothers who are dependent on the expression of pumped breast milk (initiation or continuation of milk production) due to circumstances that do not allow for breastfeeding. Hartman et al., in a 2008 study,[24] showed that the maximum comfortable vacuum enhances milk flow and milk yield. << /Contents 25 0 R /MediaBox [ 0 0 612 792 ] /Parent 43 0 R /Resources << /ExtGState << /G3 34 0 R /G5 36 0 R >> /Font << /F4 35 0 R /F6 37 0 R /F7 38 0 R >> /ProcSet [ /PDF /Text /ImageB /ImageC /ImageI ] /XObject << /X8 23 0 R >> >> /StructParents 0 /Type /Page >> Initial document development. This suction-release cycle can also be accomplished with hand pumps, which the nursing parent operates by compressing a handle. By following safe preparation and storage techniques, you can maintain the high quality of expressed breast milk and the health of your baby. [1][2] Scientific American (1863) credits L.O. It takes time to become proficient at pumping. But at first, while your milk production is ramping up, expect to pump less milk than you will later. Kh3?/5c}L>j*Jt&P\D?=/o/So"( gXi= uId3@2{H;#y~S7D:_P:J TQ]F@y2zRnH)Mr >oP:^mgYBcL\lO*F=~dY8u/%_u $m^ c+}iZqG5zVO HWmL`&^=xGNwV. The studies were conducted in the U.S. and at international sites which included preterm or ill neonates as well as term and older, healthy infants. This style provides more suction, making pumping significantly faster, and allows users to pump both their breasts at the same time. These devices are typically available in the hospital setting for mothers who have infants that are still hospitalized. MPTAC review. (1993). Pumping as often as your baby normally drinks breast milk should help your body make about the amount of milk your baby needs. and/or congenital reasons (for example, a cleft lip). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Available at: World Health Organization. Nutrient Adequacy of Exclusive Breastfeeding for the Term Infant During the First Six Months of Life. Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING study. These pumps may not provide sufficient stimulation and emptying of the breast. << /Linearized 1 /L 98409 /H [ 852 197 ] /O 22 /E 60170 /N 6 /T 98032 >> After about four to five weeks, babies reach their peak feeding volume of about 3 to 4 ounces (90 to 120 mL) and peak daily milk intake of about 30 ounces per day (900 mL). April 4, 2018. Meek JY, Hatcher AJ; Section on Breastfeeding. Infant feeding and growth. Medicaid managed care administered by Amerigroup Partnership Plan, LLC, an independent company. No. The guidelines recommend coverage of costs for renting breast feeding equipment for each birth. Artifact of the month August 2013", "Baby Food: If breast is best, why are women bottling their milk? 1: Sven Lakartidn. Updated Description/Scope, References and Websites sections. "Combining hand techniques with electric pumping increases milk production in mothers of preterm infants" J Perinatology (2009) 29 757-764, J Morton et al. Updated Discussion, References and Websites sections. This use of breast milk is widespread in the United States, where paid family leave is one of the shortest in the developed world. American historian Jill Lepore argues that the need for so-called "lactation rooms" and breast pumps is driven by the corporate desire for parents to return to work immediately rather than mothers' wishes or babies' needs. Rockville, MD: FDA. The use of specific product names is illustrative only. Factors That Affect Milk Yield Storage capacity is based on the amount of room in your milk-making glands, not breast size. At first you will probably be able to pump small amounts, and this will gradually increase as times goes on. Before you start to worry, you first need to know how much pumped milk is average. [a%S(z>@%pO%6,t*VB@Nq#uK\a}!$N"5boIr'dLSbDH p~TS7e)\` <. The portions of the pump that come into direct contact with the expressed milk must be sterilized to prevent contamination. Manual breast pump: Nonpowered device designed to express breast milk using suction created through a manual process. If the first month of exclusive breastfeeding is going well, your milk production dramatically increases from about one ounce (30 mL) on Day 1 to a peak of about 30 ounces (900 mL) per baby around Day 40.1 Draining your breasts well and often naturally boosts your milk during 5Kent, J. C. (2007).How breastfeeding works. 3Dewey, K.G. % Under provisions of the Patient Protection and Affordable Care Act, the U.S. Department of Health and Human Services (DHHS) released health plan coverage guidelines, which included recommendations from the IOM, that require health insurance plans cover breast pumps and certain other women's preventive services. Federal and State law, as well as contract language including definitions and specific coverage provisions/exclusions, and Medical Policy take precedence over Clinical UM Guidelines and must be considered first in determining eligibility for coverage. While it takes practice, skill, and coordination, it gets easier over time. stream Hospital-grade breast pump: Non-standard, electric, heavy-duty breast pump, that is FDA approved for reuse by multiple lactating women (not for single person/personal use). What should you expect when you begin pumping? Updated Discussion/General Information, References and Websites sections. Breast Pumps. 2012; (15):CD003517. Do you ever second-guess your milk supply after pumping? [7], Breast pumps are used for many reasons. [3] In 192123, engineer and chess master Edward Lasker produced a mechanical breast pump that imitated an infant's sucking action and was regarded by physicians as a marked improvement on existing hand-operated breast pumps, which failed to remove all the milk from the breast. 0s'Z ]$U.%$LMnWd OVy;(_[R L+K?&oTWe^E>JQKn6QMl Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women. Spatz DL, Edwards TM. K020375. JAMA. Ax:-_.n>h'z-#3wc~NSo?RgRDB16kr/FE0ki]cLhSr'y( 6)/@Z/~bjA2#{o=s0=YTcur^6PGOp/s\]>^wjMtpH 6NvFneMHbvla7C-+ You can offer the other breast to the baby even after you pump and baby will get more milk. Breastfeeding and human milk provide natural, normal nutrition for all infants. Pediatrics. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. While women initially report intention to breastfeed exclusively for at least 3 months, only 32.4% of the women report achieving this goal (Meeks, 2017). There are many different types of breast pumps on the market and factors to consider when choosing the best pump for your situation. "Bicycle-horn" style manual pumps can damage breast tissue and harbor bacteria in the rubber suction bulb, which is difficult to clean. If youre feeling negative and aren't pumping as much milk as usual, take a break and pump later, when youre feeling calmer and more relaxed. This will help remind your body to keep making the amount of milk your baby needs. The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Article originally appeared on the website Breastfeeding Reporter (www.nancymohrbacher.com), where you can find complete article licensing information. Obstet Gynecol. The best suction setting is the highest thats truly comfortable and no higher. Geneva, Switzerland, World Health Organization. Expressed milk may be donated to milk banks, which provide human breast milk to premature infants and other children whose mothers cannot provide for them. Effects of varied energy density of complementary goods on breast-milk intakes and total energy consumption by healthy, breastfed Bangladeshi children. The magic number and long-term milk production. endobj Updated February 2018. Op{%%=w_H'A:Q ncK>RbJQds? [16] The research found that hand expression in addition to a breast pump (a technique called "hands-on pumping", or HOP), along with other factors correlated to higher milk production. Various groups continue to support promotion of breastfeeding interventions to improve the rate of breastfeeding in the United States. July 19, 2011. I'm a big fan of Medela and Spectra pumps. Benefits of breastfeeding include a lower risk of diarrhea, otitis media and lower respiratory tract diseases than bottle-fed infants during the first year of life (AAP, 2012; Ip, 2007). Larkin T, Kiehn T, Murphy PK, Uhryniak J. Reformatted Coding section. Ann Intern Med. Available at: Ip S, Chung M, Raman G, et al. Medical Policy & Technology Assessment Committee (MPTAC) review. Most women pump more milk in the morning than later in the day. Updated formatting in Clinical Indications section. Breastfeeding. After youve had some practice using your pump and its working well, the following factors can affect your milk yield: Read on for the details about each of these factors. Hospital-grade pumps are larger and intended for multiple users. Available at: Centers for Disease Control and Prevention. Adv Neonatal Care. Breast storage capacity explains many of the differences in breastfeeding patterns and pump yields that are common among mothers.7. Updated References and Websites sections. MedlinePlus. [12], Expressing milk for donation is another use for breast pumps. Devices are available which are worn inside the bra which allow a woman to perform activities of daily living while pumping. A disadvantage of the diaphragm is that it may limit the amount of air/suction available to extract milk from the breast. Cochrane Database Syst Rev. Updated Discussion/General Information, References and Websites sections. 2Heinig, M.J. et al. Helping Hands Lactation, Pasadena, MD 21122 (410) 701-0289. The AAP recommends breast feeding continue through the infants first year of life or longer. MPTAC review. 7Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). << /BitsPerComponent 8 /ColorSpace /DeviceRGB /Filter /FlateDecode /Height 198 /SMask 24 0 R /Subtype /Image /Type /XObject /Width 874 /Length 20258 >> Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Atlanta: U.S. Department of Health and Human Services; 2013. [22], There are two types of electric breast pumps, hospital-grade and personal-use. A comparison of the efficiency, efficacy, comfort, and convenience of two hospital-grade electric breast pumps for mothers of very low birthweight infants. Rotary vane pumps use a cam with retractable vanes to create suction and are no longer widely used. What leads to unawareness in pumping women and Lactation consultants about the need to be fit with the right size flange for efficient emptying during pumping. Have you had breast surgery? 2016; 316(16):1688-1693. Updated Coding, Description, Discussion/General Information, References and Websites sections. Click here for the Breastfeeding USA website article describing this effective technique. decision for breast pumps..?I have high intentions of breast feeding, what is a good automatic breast pump that won't give out that easily? This document addresses the use of standard electric breast pumps (non-hospital grade) or heavy-duty, hospital-grade breast pumps for initiating and maintaining expression of human breast milk in specified situations. Breastfeeding and maternal and infant health outcomes in developed countries. 2007; (153):1-186. Available at: Limmerick PJs Serenity. On June 20, 1854, the United States Patent Office issued Patent No. Used with permission. [Article in Swedish] EGNELL E. J. Morton et al. [13], "Pump and dump" refers to the practice of disposing of breast milk rather than pumping it to be used. Youll know you need a different size nipple tunnel if you feel discomfort during pumping even when your pump suction is near its lowest setting. May 10, 2012. March 26, 2018. Until your baby starts eating solid foods (recommended at around six months), her feeding volume and daily milk intake will not vary by much. U.S. Food and Drug Administration 510(k) Premarket Notification Database. May 3, 2002. Importance of Vacuum for Milk Expression Breastfeeding Med 3(1) 11-19. Distilled #7: Bicycle Horn or Breast Pump? Hands-on Pumping 1Butte, N.F., Lopez-Alarcon, & Garza, C. (2002). To hand express, you use your hand to massage and compress your breast to remove milk. Exclusive breastfeeding is recommended for the first 6 months of life by the American College of Obstetricians and Gynecologists (ACOG, 2016), American Academy of Pediatrics (AAP, 2012), and the World Health Organization (WHO, 2018). Pump designs are referred to as either open or closed based on whether there is a barrier between where the tubing connects to the pump and where milk flows into the pump. Some mothers actually pump the most milk near the minimum setting. [19][20][21], Foot-powered breast pumps use the same collection tubing and breast horns as electric breast pumps, but are powered by a foot pedal. In 2011, the Institute of Medicine (IOM) Committee on Preventive Services for Women provided the recommendations on preventive services to address health needs specific to women. Also, because few women are completely symmetrical, you may need one size nipple tunnel for one breast and another size for the other. According to a 2016 survey, 81.1% of women initiate breastfeeding following birth. This comment has been removed by a blog administrator. 2013; 13(1):75-82. Talk with a lactation consultant for tips on how to help make pumping work for you. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. endobj In recent years there have been several advances in breastfeeding equipment which could encourage breastfeeding and continue for a longer period of time. MPTAC review. Some models include battery packs or built-in batteries to enable portable operation of the pump. No. ", Copyright 2010-2021, Breastfeeding USA, All Rights Reserved | Privacy Policy. These tend to operate at low speed, have high reliability, low noise, and long life. Some breast pumps are designed to be part of a "feeding system" so that the milk storage portion of the pump is the baby bottle used to feed the infant. Breast Pump, Patent No. Available at: U.S. Food & Drug Administration. Updated Discussion, References and Websites sections. That said there are some mothers that I suggest that they start pumping right from the start, these women are those that have risk factors for low milk supply, those who are separated from their baby, and those whose baby is at risk for feeding difficulty. [25] However, it is important to clean the diaphragm as condensation or milk reaching this part can cause bacterial contamination. Donor milk may be available from milk banks for babies who are not able to receive their mothers' milk. Lactation consultants, specialty medical supply stores, and durable medical equipment (DME) supply sources may rent or sell hospital-grade breast pumps. Do you compare it with the milk you pumped for a previous baby? The standard models may be available from lactation and DME providers as well as select retail stores. Expressed milk may be kept at room temperature for up to six hours (at 66-72 degrees Fahrenheit, around 20 degrees Celsius), in an insulated cooler with ice packs for up to one day, refrigerated at the back of the refrigerator for up to 5 days (optimal: use or freeze the milk within 3 days), or frozen for 12 months in a deep freeze separate from a refrigerator maintained at a temperature of 0 degrees Fahrenheit or 18 degrees Celsius (optimal: use this milk within 6 months). IH?32Z;R+o(7,7)h3`DsWI)TRO5J~"Tj >5\V RO XO Committee on Preventive Services for Women; Institute of Medicine. Revised to add medically necessary and not medically necessary indications for standard, non-hospital grade electric breast pumps. Did you have pre-eclampsia, requiring magnesium sulfate or Procardia? endobj All parts of Spectra S1 breast pump that come into contact with breast milk can be sterilized via microwave, electric steam sterilizer or cold water sterilization methods. If you find that you are not able to pump as much milk as your baby wants to eat while you are away, you may want to consider adding another pumping session to increase your milk supply. (NT$1"&b_|R+BzT7QRs American Journal of Clinical Nutrition, 58, 152-61. The member's contract benefits in effect on the date that services are rendered must be used. No. Do you compare it with the volume of milk your friend or neighbor pumps? How much milk a baby consumes per feeding varies by age anduntil one month or soby weight. Even with good milk production and a good-quality pump, some mothers find pumping tricky at first. (2006). The National Association of Neonatal Nurses (NANN, 2016) issued a position statement on the use of human milk and breastfeeding in the neonatal intensive care unit (NICU). K150721. There are many reasons you might want to pump, hand express breast milk, or feed your baby pumped breast milk.