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Breast Pumps, Nipple Shields, Hooter Hiders…Oh, My!

September 19th, 2010 by avatar

As a childbirth educator, I frequently receive letters, pamphlets, postcards and, yes, the occasional free sample of products targeted toward the expectant and new mother.  One particularly popular category of said products includes those revolving around breastfeeding.

As breastfeeding (thankfully) continues to re-gain momentum in our culture, so do the products which are developed for and marketed to breastfeeding mothers.

But what about these products?  Which ones are necessary?  Which ones are helpful?  A luxury?  Superfluous?  Unnecessary?  Ultimately unhelpful to the breastfeeding process?

As is with life in general, the answers to the above questions represent a slippery slope–the grade of that slope largely dependent upon the dynamics going on between each mother-baby duo.

Here is a non-exhaustive list of the types of breastfeeding-related products out there:

clothing:
-nursing bras, shirts, tank tops, gowns, pajamas, etc.

over-clothing accouterments meant to cover up the nursing mom and baby:
- Hooter Hiders, Baby Bond drapes, screens, slings, wraps, cloths, blankets, etc.

sore nipple treatment products:
- ointments, creams, gel pads, nipple shields and shells

leaking breasts:
- breast pads, nipple shells/covers

breastfeeding aids:
- nipple shields, nipple shells, tube feeding systems, syringes, cups,

breast pumps:
-one- and two-flanged, manual, automatic, hospital grade, hands-free pumps…

With all this equipment out there, how does a woman choose which of these items is important to have on hand upon baby’s arrival, and which products represent little more than a marketing ploy aimed at capturing the dollars of vulnerable, new parents? Which items ultimately have an influence on how we collectively view breastfeeding in our culture, which ones truly support the breastfeeding process, and which ones complicate it?

As documented and/or suggested in several recent studies (one being Kathleen Buckley’s A Double-Edged Sword:  Lactation Consultants’ Perceptions of the Impact of Breast Pumps on the Practice of Breastfeeding, as appeared in the Spring 2009 issue of The Journal of Perinatal Education and covered on this blog) a large percentage of American women view breast pumps as a necessary item on the to-get list prior to baby’s arrival.  The implicated assumption being: in order to achieve breastfeeding success, one must employ the use of a mechanical pump at some point, rather than encouraging the baby to perform the job of drawing milk from the breast on his or her own.

Of course, complicating this issue is the higher and higher percentage of women returning to work within a month or two of their baby’s births.  Whether by choice or by lack of adequate maternity leave, more women are trying to keep up with the practice of breastfeeding they so desire, all the while tending to their uncompromising duties at work (“work,” in this case, meaning financially reimbursed duties outside the home).

But here’s a seemingly little known secret:  in most cases, whether returning to work or not, long-term breastfeeding success usually depends on less accouterments than more.  And early introduction of tools like breast pumps (before, say, three weeks postpartum) and nipple shields?  They actually decrease a woman’s likelihood of achieving long term breast feeding.  (By long term, I mean, say, longer than a few months.)

Breast pumps, specifically, have some potential drawbacks: Unless a woman has an extraordinarily abundant milk letdown reflex, it is difficult to express a whole heck of a lot of milk via a breast pump.  Believe me.  I know.  I struggled for months at trying to get a breast pump to work for me, just to build up that little reserve of breast milk in the freezer for the occasional date night out or, way back when, a shift at work that kept me away from the baby beyond nursing time.

And because breastfeeding is a supply and demand system, the more you rely on the pump to generate milk for your baby, the less milk is being drawn from the breast.  Less milk “demand” equals less milk production.  Within a relatively short period of time (the body responds to a change in the supply-demand system within 24-48 hours) the woman begins to notice a decline in her milk supply.  Add to that, the visual image of how much milk is showing up in the bottle after any one pumping session (again, much less milk will come out into the bottle via the pump than would otherwise end up in the baby’s tummy via baby-to-breast feeding) and the woman starts to doubt her ability to feed her child.

Can breast pumps save the nursing trajectory for some moms and babies?  Sure.  There are a variety of scenarios in which breast pumps can undoubtedly be useful and helpful.  But that degree of assistance only goes as far as the knowledge of how to keep a woman’s milk supply up while also relying on the breast pump (basically, by adding in some extra stimulation of the breasts–a couple extra nursing sessions with the baby, or extra pumping sessions beyond the frequency of the baby’s normal nursing pattern).

And how about other items like nipple shields, an increasingly popular tool distributed by more and more lactation consultants?

nipple_shield

Are these tools the magic bullet they are so often made out to be?  Or is this a case of mistaken identity or, worse yet, blind acceptance of half truths fed to us by medical supply company salespeople working on commission?  In many cases, are products like nipple shields a divergence away from addressing, and treating, whatever the true problem is in a challenged breastfeeding situation?  Here is an excellent article that addresses these questions.

Whether it be in the realm of pregnancy, labor and delivery or breastfeeding, I see us as a general population more and more often taking the band-aid approach versus addressing underlying issues, problems and concerns head-on and dealing with them proactively and efficiently.  Going back to the nipple shield example:  if a baby and mother are having difficulty with breastfeeding due to a poor latch (the most common cause of breastfeeding woes) it’s easy to hand over a nipple shield which, when used carelessly, encourages the baby to latch on to the teat of the shield only and draw milk via isolated suction rather than suction plus significant jaw and tongue motion.  (watch this video clip and this for the proper manner in which a baby ought to latch on to the breast)

While nipple shields can temporarily help women with the most severe cases of inverted nipples:

invertednipple

or flat nipples:

flatnipple

there is not a strong indication for the frequent or regular use of nipple shields in most other situations.  The risks, however, are plentiful, as described in the article referenced above.

Of less severity are some of the other products mentioned:  special nursing clothes, drapes, etc. meant to hide mom and baby as much as possible from public view while breastfeeding.  Here, I realize, I’m opening up an enormous can of worms but…what the heck, the can is already open, right?

How many folks, when preparing to purchase one of the dozen different nursing cover-ups, stops to think about why they feel compelled to add one of these things to their collection of baby stuff?  If it’s purely a matter of mother’s modesty than, have at it.  But if it’s a concern over what other people think about the act of a woman feeding her child, well…couldn’t one argue that the mass production and marketing of breastfeeding cover-ups only furthers our culture’s still often distorted and prudish views of breastfeeding?

So, if you’ve made it to the end of this post, you’re likely looking for a conclusion.  My conclusion would be this:  think carefully about the products you buy in regards to feeding your child.  Think even more carefully about the products you recommend to an expectant, new and/or nursing mother.  Consider who will ultimately win at the end of that purchase:  The mother?  The baby?  The company who has happily sold another well-marketed product?

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  1. September 19th, 2010 at 14:34 | #1

    I’m glad that others are talking about this. I needed nothing to breastfeed [except a baby :-)] — never used a Boppy or any other type of nursing pillow, nipple cream, or anything else. Except a breast pump. Traveling for 10 hours by car with a one-month old to a family funeral, I felt it necessary – I could pump and feed him w/o having to stop every few hours. [Now I know I could actually nurse in the car with him still in the car seat, and me buckled in next to him.] With both my babies, I had over-supply issues, so while I spent those first several months after my first son was born trying to decrease my supply; with my second, I used a breast pump and gave the extra milk to a friend for her adopted baby.

    Considering that breastmilk is “liquid gold,” I would highly encourage women to pump so that they can donate their milk to those who need it, whether via the closest milk bank, or to a local hospital, or even a person-to-person exchange. [Obviously, only if they don't have any diseases that can be transmitted via breastmilk, of course.]

    But, yes, in general, the more there is between a mother and her baby, the harder breastfeeding is going to be, so I never suggest to friends any item as a “must have” for breastfeeding.

  2. September 19th, 2010 at 15:04 | #2

    I’m one of those that will recommend at least a cheap handheld pump be bought before the baby comes. I was NOT one where supply was an issue- we ended up running to target as I soaked through my shirt to buy nursing pads and a breastpump to help manage the milk I was getting (I swear I could have fed 4 babies that first week, and my son was jaundiced and not eating hardly at all, I didn’t want all that milk going to waste). I literally was sitting in the bathtub with two fountains of milk pouring out of me, I didn’t even need to pump- I just used the pump as a “catcher”.
    I don’t think recommending a breast pump necessarily implies a lack of an ability to do it on your own- in my case, my body was functioning a little too well. I went on to breastfeed for over a year, and pretty much never used the pump beyond those first few weeks as my supply regulated.

    As for the other things- yes, I agree. It’s an overall theme for bringing home a newborn: there are so many gadgets and “must-haves” when really a new baby and mommy NEED pretty much nothing, it’s all built in.

  3. avatar
    Tatiana
    September 19th, 2010 at 15:36 | #3

    “And because breastfeeding is a supply and demand system, the more you rely on the pump to generate milk for your baby, the less milk is being drawn from the breast.”

    Huh? I guess if I really parse the sentence this makes some sense. Yes, if you’re relying on the pump to generate milk for the baby IN PLACE of nursing, then it could follow that less milk would be drawn & produced. A baby can successfully extract milk when the breasts are not very full, but a breast pump would cease to be able to pump at that point of fullness. But if you’re nursing plus pumping, I don’t see how that would lessen your supply.

    I’m sure it happens, but I’ve never encountered people pumping milk in place of nursing other than for work, sharing care with a partner or other family, or one of the very rare physical conditions that precludes directly nursing a baby. People who could nurse pumping milk to then give it to the baby in a bottle? Anyone know any rates of that?

    Why would you? I can see how that would lead to a shorter period of “breastfeeding” (more like bottle feeding breastmilk) because pumping is a utilitarian activity devoid of most of the fulfilling and gratifying aspects of breastfeeding. But I wonder whether the prevalence of that manner of using pumps warrants lumping them in with the largely frivolous stuff you’re talking about. They clearly manage to make ongoing breastfeeding realistic within the constructs of modern life for many (if not most) people who use them.

  4. September 19th, 2010 at 18:50 | #4

    I agree wholeheartedly that there are far too many accoutrements… Nipple shields are especially over-used, thank you for the photos!

    However, I think the author gives short shrift to the necessity of breast pumps for working mothers. And very FEW women I work with have trouble pumping enough for their babies — I’m afraid this article might send the message that working mothers should not even bother because they’ll never pump enough. That would be a shame! Evening La Leche League meetings typically attract many working moms with a plethora of tips for pumping as needed.

  5. avatar
    Summer
    September 19th, 2010 at 19:57 | #5

    This was a FANTASTIC post. I never used a pump because I’m like a dairy cow. I bought a “Milkie” and put it in my bra each time I nursed my daughter. I caught about 2oz of drip each feeding for the first several months and would save it in the freezer. It saved lots of money on breast pads and I never had to go through the process of pumping.

    Also, I have inverted nipples and never, EVER used a nipple shield. Unfortunately for me, breastfeeding is quite uncomfortable for a couple of weeks but once she drew my nipples out, things were much more comfortable and latch has never been an option. It CAN be done without the shields, and I am proof of that. It took a little tooth gritting but it was well worth it. My daughter is now 12 months old, and still nursing, showing no signs of stopping.

  6. September 19th, 2010 at 22:05 | #6

    This is great! I’m all for decreasing the amount of junk that gets bought for babies who don’t need it.

    Before I had a baby I laughed at all the nursing covers I saw. Once my baby got big enough to be distracted by anybody else being present in the room, I saw their merit – not to hide us, but to help her to focus. But I didn’t buy more Stuff, I just used a receiving blanket.

    A breast pump was a critical tool for me when my newborn was in the NICU and couldn’t even be held, let alone breastfed. The pump was absolutely the thing that kept my supply up, and allowed my baby to be fed my milk before she could be nursed. I’d hate for anybody reading here to think that a pump would have the opposite result. However, this isn’t a vote to buy a pump before baby comes. In this kind of medical emergency insurance will often cover one.

  7. avatar
    Rachel Cintron
    September 20th, 2010 at 04:33 | #7

    For years I was thought that “if only we could make breastfeeding profitable!” we could counter the formula industry with equal corporate partners, so while all these tools may not be necessary, the fact that this market exists is a) a sign that things are changing and b) perhaps a sign that things will change more? Let’s market breastfeeding the way formula has been marketed!!

  8. avatar
    Meghan
    September 20th, 2010 at 06:47 | #8

    @Kathy
    How would you breastfeed an infant in a carseat with yourself buckled? My LO is 2 months, we have a typical infant “bucket” seat and we also have a larger convertible seat (though not using it yet), and she hates the car…but loves to nurse. I would like to try nursing her in the car to calm her down.

    I got my BF “gear” from my sister…a Boppy and a pump (she only used it sparingly). I’ve barely used the pump, my LO does a great job of latching and feeding. Though my husband liked giving her a bottle of expressed milk yesterday. Next weekend I plan on going back to a longer yoga class because now he can feed her too!

  9. avatar
    Augusta
    September 20th, 2010 at 08:41 | #9

    My first child, I used pretty much all the breastfeeding products. By the third one, I didn’t use anything except some Lanolin from time to time. However, I was working part time and going to school full time with my first, so the pump really helped me to continue to breastfeed my son in spite of how many other things I had on my plate. And I didn’t notice a low supply or decreasing supply at all.

    I got really sick of nursing bras and ditched them some time during the infancy of my second baby. After that, I just started pulling up my normal bras over my breast. That worked out better for me.

  10. September 20th, 2010 at 10:48 | #10

    I am always happy to hear people address the issues with nipple shields! When I had my first child, the hospital lactation consultant must have become frustrated with my extremely flat nipples and my daughter’s latch issues ~ first she told me “not everyone has to breastfeed” and then when I insisted I was going to, she gave me a nipple shield. Fast forward 2 years ~ I was never able to get my daugther to switch off the shield, and I nursed her for 26 months like that, becoming increasingly convinced I was just defective and would never nurse a baby normally. I am so thankful for having wonderful midwives for my second daughter ~ their help and support is what gave me the informaation and ability to realize I didn’t need a shield, and they should not be handed out in place of addressing the REAL issues behind difficulty breastfeeding!

  11. avatar
    Beth
    September 20th, 2010 at 14:58 | #11

    I’m glad to read the comments supporting pumping, because this article gave off the impression that I should just give up on the idea of breastfeeding my baby-to-be while I work. I’m 20 weeks pregnant, and I’ll need to go back to work after 12 weeks leave. My partner and I simply cannot afford to support ourselves, much less another person, without both of us working (fortunately opposite schedules, so childcare is easier). Thank you, other commenters, for following up with reassurances that I’ll still be able to breastfeed and work!

  12. September 20th, 2010 at 20:42 | #12

    To all commentators:

    Thank you, thank you, for continuing this discussion…especially those of you who shared segments of your personal stories and those who suggested need for clarification regarding returning to work and successfully continuing breastfeeding. To be discouraged about working outside the home and continuing to breastfeed a child as long as is it is mutually beneficial for mom and babe is the antithesis of what the take away point should be here.

    To those who feared this article some how discourages breastfeeding for moms returning to work (especially in light of the discussion about breast pumps): this is not true at all. (Thus my statement, ” Can breast pumps save the nursing trajectory for some moms and babies? Sure. There are a variety of scenarios in which breast pumps can undoubtedly be useful and helpful.”)

    For moms who choose/need to return to work soon after their babies’ births (or at any point while still nursing), the continued breastfeeding relationship IS feasible, and breast pumps DO play an important role in this dynamic. Thus my comment on making sure extra nursing/pumping sessions are implemented to keep the amount of demand high enough to ensure a plentiful supply. This coincides with Tatiana’s statement about nursing plus pumping. (Extra nursing sessions are essential and will make up for the decreased demand effected by the breast pump–even if the pumping is achieved “on schedule” with when baby is being bottle fed when away from mom.)

    I have known MANY women who successfully continued breastfeeding long after returning to work–having used a good quality breast pump sometime, and perhaps all, along the way. The point here is to understand the physiology of breast milk production and which items are truly helpful (and in which scenarios they are helpful) and which ones are non-applicable, unnecessary, or often incorrectly used.

  13. September 21st, 2010 at 07:50 | #13

    @Meghan
    Meghan, I’m not sure what kind of car seat I had; I guess it was the bucket kind — there was a base that you could leave in the car, while you pop out just the car seat if you wanted to. You could also buckle in the car seat without the base. [Sorry that I don't have the car-seat lingo down. :-)]

    Anyway, once I realized that when I buckled in the car seat w/o the base, it left the baby low enough for me to lean over him, I tried nursing him when he was fussy, and it worked. [It may have helped that I am, ahem, rather "blessed" in the breast department; but I think even a smaller/normal-sized woman could get it to work.] I can’t remember what prompted me to try it; but I’ve since talked to a few women who also said that they had done that.

    So, try it and see if it works.

  14. avatar
    Karen
    September 22nd, 2010 at 11:30 | #14

    Thanks for another great post! The issue of “privacy drapes” is worth mentioning all by itself. Just the presence of these drapes on store shelves suggests that nursing is so disgusting to bystanders that we shouldn’t be breastfeeding in public at all, but if we must – be sure to wear a tent out of consideration to others.

    I think there are many new moms who, in the first few weeks, erroneously feel they are exposing their breasts while latching on. The best advice I got on this was to try latching on in front of a mirror. Then you can see exactly how much you are – or in truth, are NOT – exposing to the world’s view. In most cases, your shirt provides plenty of modesty. As Sarah said, a receiving blanket can keep an older baby from being distracted, but it’s not necessary for modesty reasons.

    I definitely take issue with the notion that breastfeeding is such an obscene act that we have to cover up and pretend we are not doing it at all. The problem there lies between people’s ears, not under mom’s shirt or in the baby’s mouth.

  15. September 24th, 2010 at 12:47 | #15

    @Tatiana I’ve actually known many women who, after a difficult first few days/weeks (can’t get baby to latch, nipples hurt too much, etc), decided it would be “easier” to just pump exclusively and feed the baby breastmilk in a bottle.

  16. September 24th, 2010 at 15:53 | #16

    I’m a fairly modest mom, breastfeeding my 4th now, and I have no idea why a person would need a hooter hider. The name says it all, doesn’t it? Hooter. Things that we can expect to make men hoot. LOVE it! I do wear nursing shirts to keep my belly covered, but a nursing cover just draws attention to what you’re doing and says “Look how shy I am about my boobs!”.

    Personally, I expect better of the men around me, and the men around me have been (as they should be) capable of not seeing me as a sex object while feeding my children. That includes every stranger I’ve nursed around in public. I think women are way, way too concerned with what other people are going to think. My experience has been that you get the kind of treatment you expect. And I expect the people around me to behave like adults. If anyone ever bothers me about breastfeeding, I’ll educate them. I’ll be darned if I’m going to hide behind a curtain when I’m not doing anything embarrassing.

  1. September 19th, 2010 at 21:41 | #1