By Melissa Belli, MD
When asking mothers why they stop or cut down on breastfeeding, a significant proportion say returning to work was the deal breaker for them. The difficulties of pumping at work and the inconvenience of the current pumping technology greatly influence a woman’s decision to continue to breastfeed. According to the Centers for Disease Control 77% of mothers in the USA initiate breastfeeding, yet only 16.4% are exclusively breastfeeding by 6 months (49% still breastfeed at 6 months but not exclusively). According to the Bureau of Labor Statistics 70.5 % of all mothers with children under 18 work and 57.7% of mothers with children under the age of 1 work. Given the high participation of women in the workforce it is clear that in order to promote breastfeeding before and beyond six months we need to improve a mother’s pumping experience at work.
My personal pumping experience illustrates the main challenges. I am a family doctor and work at various office settings and urgent cares. The first challenge was informing the different office managers that I needed a place to pump; uncomfortable conversations ensued with people that didn’t face this kind of request very often. I was lucky to have very nice and cooperative employers that allowed me to use patient rooms or offices to pump, but I am sure many women deal with less cooperative management.
The second challenge was transporting all the equipment; I had to carry my purse, lunch box and the heavy pump bag with all the tubing, cups, diaphragm membranes, cooler, etc. The weight and bulk made it hard to move and I can’t imagine commuting on public transport with all that bulk.
The third challenge was finding a time and place to pump. In the rush of urgent care and primary care medicine, time was hard to come by. I had 30-60 minutes for lunch, which I had to allocate for completing patient notes, lunch, and pumping. I didn’t automatically get pump breaks in the patient schedule, so beyond what was allocated for lunch time, pump time required further bargaining. Appointments were back to back, and often visits required more time than expected. In this scenario I had to find a private room with a lockable door, to avoid any breast pump flashing, then pull out the device, plug it in, hook up and turn on the machine for a total prep and pump time of about 20 min. This needs to be repeated every few hours and can cause havoc on your schedule.
The fourth challenge was keeping together, functional and clean all the equipment required for pumping. This required a lot of prepping the night before and in the morning of. There are innumerable parts to most pumps, assembly, dis-assembly and cleaning are needed with each use. In the beginning, I found myself forgetting pieces of the pump at home and having to do a mad dash to the nearest Toys r Us to buy the missing pieces, then returning to work to pump with breasts engorged, hungry and patients waiting. It was crazy and pretty stressful.
When you put it all together; hard to assemble and take apart, multiple pieces and limitations, plus the fact that most pumps are definitely designed to be used in a very private setting, as the look is embarrassing even among family and friends, and you find yourself with a machine that is hardly user friendly.
I propose a total redevelopment of the breast pump. I dream of a system that would be wearable–like a hi-tech bra–was very silent, would not require taking any clothes off, was fast, hands free, and stored milk in such a way that I could just pull out a full cartridge from a belt pouch and place it in the fridge or cooler. I would be able to pump at my desk, with the door open. It would hook up to my car so I could pump while commuting. It would not require a lot of parts so these would not be inadvertently forgotten; it would beep if something was left behind. It would be easy to assemble and clean, dish washable and spill proof.
The Freemie is a on the right track, this collection system has a collection cup shape that can be placed in the bra; it is hands free and does not require taking any clothes off.
I am sure we could do even better. Pumps and lactation support services are now covered by insurance, which should translate into growth for the pump market. Some of these funds need to be made available for research and development. Maybe even the military, with so many women joining its ranks, could allocate funds to the redevelopment of the breast pump for the active duty mother.
This new pump would do wonders for breastfeeding. Mothers want to do the best for their children and try hard, but often the obstacles ahead of them are numerous, persistent and exhausting. Let’s put our amazing technological skill at the service of mothers and babies. We have put people on the moon, it is time we focus on more earthly targets and give mothers a high tech breast pump they can work with.