Thanks to Victoria Nesterova and JSI, Ukraine for a great video illustrating baby’s attachment at birth — safe, warm, ready to nurse.

– Susan

Evidence-based recommendations from the World Health Organization, to prevent hypothermia, using skin-to-skin contact, delay of bath and exam and other steps. Video created by JSI, Ukraine, used with permission.

You can learn about provisions of the law, how you can seek enforcement, and what the penalties are if your employer doesn’t comply (sadly, none yet specified but the mother may actually have a civil rights claim if she has been treated differently than other people).

Contributed by Christy Porucznik

Troubleshooting

This is a common scenario presented at LLL meetings, “I have returned to work and am pumping for my baby and suddenly I am not getting as much as I did before. I guess I am losing my milk and will have to start using formula.”

Maybe, but it is more likely that something else in your environment has changed.

Milk production is a demand and supply system. The more milk that you remove from your breasts, the more milk your breasts will produce. If you notice less production when you can actually see it, then the most likely cause is that less has been demanded from your breasts.

First, check the pump.

Is there a cut in one of the tubes? I accidentally ran over the tubing once with my office chair and cracked it, resulting in dramatically different suction. If there is a break in the tube, do not despair, depending on where the break is you can simply cut it and then replace the flange attachment at the new cut site. This can get you through until you can buy a new tube (so that it is long) or forever. I have been using one short tube for months.

Is there a tear in one of the white flexible membranes? You need to pull on them a bit to see if they are completely intact. Often there will be a tear that you can’t see if you just look at it, but if you pull a bit you will see the hole. This ruins your suction. Keep a spare around. This is the 2 cent piece of plastic that makes the pump work after all.

Have you changed the way you operate the suction? Changes may help or hurt depending. Sometimes I find that I need to turn up the pressure a bit, but generally I use the lowest setting. Sometimes if the milk ejection reflex seems to be slow I will turn the pump off and then on again to get back to the initial fluttery sucking stage. This sometimes stimulates another round for me. Bottom line — play with those knobs and see what happens. Your baby doesn’t nurse the same way every time after all!

What day is it? Many moms find that they pump less volume each day that they work so that Friday they don’t bring home the least milk. This makes sense because if you have been away from your baby all week working you aren’t likely pumping as often as he is eating AND pumps aren’t as good at milk extraction as babies. Your breasts are compensating by not producing what isn’t being demanded. On the flip side, many moms report that they pumps lots on Mondays after nursing their babies all weekend. Production responds to demand.

Has your baby been nursing differently? For example, has he been sick and nursing less, or have you started more solids and perhaps cut back on nursing sessions when you are together? Production responds to demand.

Have you started a new medication or been ill yourself? Both of these can be associated with reduced milk supply.

What’s to be done?
Nurse your baby more often.
Replace any broken parts on the pump for when you can’t be with your baby.
Repeat.

As you remove more milk, your breasts will produce more milk. Elegantly simple system.

If none of these ideas seem to help or at any time, phone a La Leche League Leader. Helping women work through breastfeeding concerns is what they do.

Contributed by Christy Porucznik

Used pumps, what’s the big deal?

Many popular, consumer-grade pumps are single-user products and are regulated by the FDA as such. Medela Pump in Style is an example of a popular, single-user pump. Ameda Purely Yours is a closed-system pump which could, theoretically, be used safely by multiple mothers without the worry of infection as long as each mother had her own milk collection kit.

Although small, there is a chance of infection being passed from mother to mother with the pump as the vehicle. HIV and hepatitis are the ones that get tossed about, and that would be really rare, but the probability is not zero. I think a more likely pathogen transfer via a used pump would be thrush (yeast).

Now is when someone says, “But I know my friend/sister etc. doesn’t have those diseases, and pumps are expensive. Why shouldn’t I take hers?”

Here is a reason:
These devices have a 1 year warranty. Manufacturers expect that 1 year is about how long people might use them, and performance will begin to deteriorate over time. A mom relying on an old pump to express milk or maintain supply may not realize that it is not as effective as it should be and her supply may dwindle as a result, or she can’t pump enough and winds up turning to artificial milk for the care provider to use.

The issue of pump life applies to the single-user devices and the closed-system devices.

* Particularly for moms considering buying used pumps from the internet or a yard sale *
This is a bad idea because: 1) possibility of infection, and 2) if you spend $100 and the thing conks out then you have no recourse or warranty and will likely wind up spending for a new pump or artificial milk anyway.

It’s true, pumps are expensive, but I submit the following:
1) many moms who think that they need a pump don’t really need it — mom returning to work full time probably does need a good double electric pump, but mom wanting to express milk occasionally for a caregiver can do just fine with hand expression or a good manual pump (much cheaper)
2) medical insurance may cover the pump as durable medical equipment – mom should check with insurance company
3) mom returning to work should find out if there is a pumping room at her workplace – there may be, and it may be equipped with a hospital grade pump. It’s true that most workplaces don’t have such amenities, but the more people ask the more common they might become. There are resource guides available for workplaces about how to create such a room and how it can benefit the company.
4) moms who receive WIC and must return to work can often get a hospital grade pump to borrow from WIC

Do people buy used pumps? Sure, but it is a good idea to consider the risks and costs and make a smart decision. If I were planning to use a pump regularly for several months I would decide it is worth the investment to know that it is both safe and covered by warranty. If I only needed it for occasional use, then I might consider a manual pump (new or used) that is both cheaper and can be sterilized.

I would not sell a single-user pump at a yard sale or donate it to a charity. If it were a share-able (closed system) electric pump, I still wouldn’t because of the pump life issue and possibility of compromising milk supply in an unsuspecting mom. I would sell a manual pump that could be boiled.

Thinking about eco-consciousness, it bums me out that these devices aren’t built to last for generations, and I would love to know what I could reasonably do with the old Pump in Style in my closet (any my current PIS when I am done with it). I have been considering what sort of science experiments or plant watering system I could build with a small electric pump. A La Leche League Group or a childbirth/parenting/breastfeeding educator might use one donated pump for teaching purposes.

As often happens, we came to the topic of pumps and pumping, and I thought it would be useful to re-post something that I originally wrote last summer.

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I am often asked about breast pumps, when to buy, which to buy, buying a used pump, troubleshooting etc. So often that I have developed standard answers which I will share with you in segments.

When to get a pump – it’s later than you think!

Pumps are on the list of ‘must-haves’ from baby-industrial-complex retailers. Why? Because they want you to buy stuff. Let me say this clearly, not every breastfeeding mother needs a pump. Pumps, particularly the double electric ones that get so much ad space, are expensive. Yes, it would be nice to have someone else purchase it for you, but wouldn’t it be even nicer to have the money or equivalent in other stuff (perhaps diapers) if it turned out that the pump was going to sit in the closet? Therefore I submit the following suggestions for different situations.

Employed mother, planning to return to work full-time, outside the home, where baby is not welcome: You will need to express milk in order to maintain your supply and have something to feed your baby while you are away. Most mothers in your situation find that a double electric pump is the most efficient means of milk removal.

First, have a chat with your employer. As a part of healthcare reform, your employer is required to provide time and space for milk expression. Perhaps your employer will also be interested in creating a dedicated milk expression room equipped with a hospital-grade pump. Benefits of hospital-grade pumps include long lifespan, efficient to use, ability to be used by more than one mother (not at the same time!) by having individual collection kits.

If your employer isn’t ready to shell out for a common pump, read your health insurance policy and/or call a representative to find out if you can get a pump as part of your durable medical equipment (DME) benefit. In this scenario, your healthcare provider writes a prescription, and you fill it through the insurance company’s DME provider. You may not get to choose which brand you get, but I for one am willing to sacrifice some choices for a savings of a few hundred dollars. With my second baby I used this route and got a new double electric pump delivered to my home for a $25 co-pay.

If your insurance won’t cooperate, then you will likely be purchasing a pump yourself. Wait until after your baby is born. Why? Well, it may turn out that you have a lot of other gifts to return to some major retailer and can use the credit generated towards the pump. There may be some change in your life circumstance such that you don’t need to return to work or can work part-time instead of full-time. If there is some unexpected or unfortunate circumstance and your baby isn’t able to breastfeed immediately you will need a hospital-grade pump in order to help establish your milk supply. The hospital will help you arrange this, and it might change the response from your insurance company.

Even if you have to pay full price for a pump, it is a better value than buying artificial milk!

Employed mother, planning to return to work part-time outside the home or in a setting where baby is welcome: You may not need to buy a double electric pump. For short separations a good quality manual pump or hand expression may suffice. Best scenario might be to keep your baby with you while you work, if that is possible. If you do want to acquire a double electric pump, see above suggestions.

No planned separation – mother is primary caregiver for baby: You don’t need to spend a lot of money on a double electric pump! If you want to be able to express some milk for a temporary caregiver, invest in a good quality manual pump or learn to hand express.

I was pleased to see a very similar discussion included in the new, 8th edition of The Womanly Art of Breastfeeding!

– Susan

Lactation Expenses: Breast pumps and supplies that assist lactation are considered to be medical care under IRC Sec. 213(d) because, like obstetric care, they affect a structure or function of the woman’s body. If the remaining requirements of IRC Sec. 213(a) are met, expenses paid for breast pumps and supplies that assist lactation are deductible medical expenses. Reimbursements for these expenses under Flexible Spending Arrangements, Archer Medical Savings Accounts, Health Reimbursement Arrangements, or Health Savings Accounts are not taxable income. IRS Ann. 2011-14, 2011-9 IRB .

Currently, local mothers interested in donating milk must find a lab to screen their blood, store the milk in their own freezers, purchase dry ice, and ship their supply to a milk bank outside of Utah. The new Mothers’ Milk donation site will reduce the barriers and personal costs of donation. Potential donors will be pre-screened and can drop off their collected milk at the Redwood Health Center. The center will then ship the donated milk to the Mothers’ Milk Bank in Denver for processing and distribution.

The World Health Organization recommends feeding infants human milk from a donor mother if the child’s own mother’s milk is not available. The Human Milk Banking Association of North America sets the standards for milk banking which include health screening of donors and pasteurization of donated milk before it is distributed to babies. The Mothers’ Milk Bank in Denver is the nearest source for donor milk for Utah babies.

A generous grant from the Herbert I. and Elsa B. Michael Foundation has supported the initial costs of the Mothers’ Milk donation site, and the University of Utah’s Redwood Health Center is providing space and staff support.

Recently, Regina Benjamin, M.D., Surgeon General of the United States, issued a Call to Action to Support Breastfeeding (http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf) which includes: “Action 12. Identify and address obstacles to greater availability of safe banked donor milk for fragile infants.”

Potential donors should call The Mothers’ Milk Bank in Denver at 877-458-5503 to begin the screening process. For more information, visit healthcare.utah.edu/redwood or email milkdonation@utah.edu.

We will meet in the main conference room at the Redwood Health Center (1525 West 2100 South), door on your left from the main lobby, from noon – 2pm.

You don’t have to stay the whole time!

To help us plan, please let us know that you are coming – you can respond to slmilkdonation@gmail.com.

If you can’t come but want to send along a comment or question, please post on the wall or send us an email!

Thanks! Christy