Dear all:

At the risk of having to put on an asbestos suit, I will pipe up again about what I feel is an 
inappropriate blanket statement.

Saying that a pump causes mastitis has about the same evidence as saying the cold weather 
causes the flu.  Flus are caused by viruses and mastitis is caused by bacteria.  Cold weather may 
weaken the immune system setting the stage for a virus to take hold, but the virus must invade 
the body first.  Ditto for misuse of the pump OR I would say what I see more of in my particular 
population is inappropriate feeding schedules that lead to inadequate drainage of the breast.

So the primary cause is the bacteria which can take hold by a variety of problems that can lead to 
inadequate drainage.

Appropriate use of the pump does NOT cause mastitis.

I happen to see a huge number of women who have totally inadequate supply by week two 
because they have a baby that is feeding poorly, needs supplement and they were told NOT TO 
PUMP before two weeks.  Then I am led with the difficult job of helping her rebuild her supply after 
the easier window of early opportunity for establishing the supply is lost.

So, while pumping for some inappropriate reasons can really cause problems with the synchrony 
between mother and baby - it is not the pump that caused the problem it is MISuse of the pump.

Let us not make blanket statements that may prevent problems for some women while causing 
problems for other women.  

Where would Paula Meier's low income mothers of very tiny premies end up if they followed that 
blanket advice of not using a pump for the first two weeks?

Also, since I work with mothers who rarely come out of the hospital without having used formula 
and rarely have followed on "cue" feeding, I have to say that, used APPROPRIATELY, the pump can 
be used appropriately to restore the natural synchrony between mother and baby.  

Many times I get the rock hard engorged mother who didn't really follow the on "cue" schedule on 
the second night.  With reverse pressure softening when the breast is edematous, judicious use of 
hand expression and judicious and appropriate use of the pump, this situation can be corrected.

Also, with the advice of Christine Smillie and Dr. Mona Gabbay it can be used judiciously to tamp 
down the oversupplier that is producing 60 ounces a day.  That very thorough draining followed 
by long stretches without using the pump is very scary when you first try it with such a women.  I 
remember thinking that this would probably drive my poor client into making 120 ounces a day.  
Not true.  It has proven to be a great technique for tamping down the oversupplier and training 
the baby that licks the milk off the breast how to start pulling after that thorough drainage.

Best regards, Susan Burger, MHS, PhD, IBCLC

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