Hi, Nikki.
       I am not an expert, but I'll share what I've seen over the years.  As
I understand it, the difference between purchase pumps and the *true*
"hospital-grade pumps" is how closely the suck mimics the suck of a baby who is
breastfeeding appropriately.  Notice, I said, "true" hospital grade.  That includes
Medela's Classic (and I guess, the Symphony, though I'm still trying to
determine that) and Hollister's Lact-e.  It does *not* include the Lactina or the
Elite, which are designed for mothers whose babies are breastfeeding correctly
and coming to breast regularly, but who are missing 3-4 feeds/day due to work
or school.  The Lactina and Elite are equivalent to the purchase pumps, and the
sales reps of these companies have confirmed that to me.  (I am only familiar
with these particular brands because these are what are available in my area.
 We do not have White River, Whittlestone, or any other brands available for
rent here, so I can't speak to those.)
       When a baby is nursing properly and coming to breast regularly, he is
helping to provide stimulation to maintain and build supply, so the
non-hospital grade pumps don't have to be so technologically similar to correct
breastfeeding.  They can be a little less similar and still be fine for what the mom
needs.  But when baby is not coming to breast or is feeding incorrectly, then
the pump must have a suck that is technologically closer to correct
breastfeeding sucking in order to maintain supply.
       Now, of course, I have run into exceptions--moms who have been able to
maintain a complete supply for their baby's needs using a purchase pump or a
less-than-hospital-grade rental pump for months on end.  But way more
frequently, I come into contact with mothers who decided to stop trying to put baby to
breast (or baby never latched in the first place) and who have been using one
of the non-hospital-grade pumps for 2-3 weeks and now their supply is
significantly diminished.  When these moms switch to a Classic or Lact-e, their
supply quickly increases again.
       And I also see moms who do alright with the non-hospital grade for 2-3
months, but then start having trouble.  I liken it to the mothers who have
been using nipple shields, but baby has not been nursing absolutely correctly
though no one worked with the mom to fine-tune baby's style, and mom didn't know
any better.  In the first few months, mom's hormones are high and it seems
that if the baby's suck is *close* to being right, the hormones plus the
almost-right suck keep the supply at the necessary level.  But once the hormone
levels have dropped significantly (month 2-3), then the baby's not-quite-right suck
all by itself is not enough to maintain the proper supply.  Then we get those
babies in the doctor's office at 3 or 4 months, and they have not gained
enough weight in the previous month.  I think that is also what happens when the
supply drops after a couple of months of using a "close-but-not-quite-right"
pump.
       Now I realize that many people feel that if the mom can keep her
supply up by taking various galactogogues, then the non-hospital-grade pump is
"working just fine" for her.  I do not feel this way.  I think that in normal
cases, a mother's body ought to be able to respond to correct suck with plenty of
milk.  And I figure that those moms who are having to pump, bottle-feed, and
then clean up all the equipment so they can do it again, are already doing
"triple duty" and don't need more stress by my telling them to go out and buy this
or that galactogogue and make sure you don't run out.  I will try various
methods to increase supply if the mom is already using a hospital grade pump and
is having supply problems, including suggesting galactogogues.  But if the mom
is not using a true hospital grade pump, I first suggest that she consider
changing pumps because many times I have seen that this is the only thing needed
to get the supply up where it should be.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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