A Treatise on Pumping: the Design Flaws of the Traditional Breast Pump
The new parent journey is filled with surprises and an extremely steep learning curve. One of the most challenging areas for me was feeding, specifically pumping. With a baby who was born a few weeks early, I turned to exclusive pumping, and the pump became a critical tool in the toolbox in order for me to maintain adequate milk supply and help reach our nutrition goals.
Before my baby was born, I had no clue that there were so many pumping accessories and parts and that configuring them required so much experimentation. I joked that the reason the period after the birth is called "postpartum" is that every night during the 3AM feed, I'd be buying pumping parts to optimize the operation. I've previously expounded on the topic of interoperability and matching up the bottle neck sizes to the pump in use. I'd like to narrow in on the flange, the funnel-like part of the pump adjacent to the breast, and where I've seen immense anecdotal evidence that we are doing a massive disservice to new moms who just want to feed their babies.
A pump for every mom
With policy changes in the US, every mother qualifies for a breast pump through insurance. The pump typically comes with two sets of different-sized flanges (e.g., Medela: 24mm and 27mm, and Spectra: 24mm and 28mm). While the diameter of the average woman's nipple has been observed to be around 13 mm, during the pregnancy and postpartum period, the nipple can widen, such that at term, the average nipple width has been measured as 15.9 ± 2.3 mm (P < .001).
If the average woman's nipple at term is just around 16mm, why are the 24mm flanges the smallest sizes that are sent by the major pump manufacturers? According to Medela, "24 mm is our most standard size based on data we receive from our healthcare experts." Our bodies' physiology does not conform to "standards". In this particular area, standardization comes with significant perils. When the flange is too large, the pump suction will pull in the areola in addition to the nipple, which makes pumping both inefficient and extremely painful. This can lead to issues such as undersupply, clogged ducts, and other more serious conditions like mastitis.
A poor fit has poor consequences
I've seen many capable women attempt to pump and find that they cannot really produce via pumping. They end up thinking there is something wrong with them or their anatomy, or may come up with workarounds or "hacks" to get the milk out while pumping. One friend ended up using manual breast compression during pumping, which gave her a repetitive strain injury. She shared, "for 9 months I needed to massage my breasts for 1-2 hours per day. If that's not a recipe for a repetitive strain injury, I don't know what is."
Lactation consultants often share guidance about how to more accurately fit flanges. I have often heard the refrain, "when in doubt, size down", which, while a helpful rule of thumb, doesn't truly guide new parents to identify the best flanges for them.
We need better options
Wouldn't it be more expedient to help women get a correctly-fitting flange in the first place - to make the right thing the easy thing by choosing good defaults? There is no reason that suffering should be a requisite part of the process. As a colleague shared, "I remember saying that I could just about imagine giving birth again, but I couldn’t imagine doing another year of milk."
In the past 5 years, I've been really happy to see innovation in the space, including new companies such as Elvie and Lilu dedicated to improving the processes and culture around breastfeeding. While we have a long way to go, it's great to see this trend and I hope that we reach the point that I no longer need to give new moms pumping tips and sizing instructions to make up for a product that is not serving them well. I am *pumped* to see this evolve, and hope that other new parents will have access to more elegant, intentionally-designed devices that truly solve this problem and make pumping a pain-free and efficient experience.
Do you have a pumping story to share? I'd love to hear from you!