In my experience as a hospital LC and working with/referring to WiC peer
counselors and IBCLCs in north Mississippi USA, the issuance of a pump is
not a given, nor taken lightly. My understanding is that there are 3 levels
of need for pumps. (1) A manual pump may be issued if a mother is dealing
with a problem such as engorgement, or some such short term challenge. (2) A
double electric "working moms" pump is issued at approximately 4 wks
postpartum if a mother is going to be going to work or school, and this has
to be more than a certain number of days per week, for example if you are in
school one half day per week, you probably wouldn't be issued this pump. (3)
Mom is loaned a hospital grade pump if has a sick or preterm infant, or is
similarly separated from infant or have a long term challenge such as cleft
lip/palate.

Disclaimer: I do not work for WIC and may not have this exactly right, but
this has been my experience.

Sometimes I contact a WIC bf counselor and ask that mom be issued a hospital
grade pump due to poor milk transfer in a late preterm infant, for example.
Sometimes the counselor would like to work further with this mother/baby
dyad to see if bf can be improved, rather than issue the pump. That is to
say, the counselors I have worked with are not overly quick to give a pump
w/o evaluating a true need for same. To me, this is always one of the
toughest judgements to make, when and if mother needs to express in addition
to her bf efforts.

In my practice, too, I have to evaluate the need. I'll give an example. Had
a mom this week with a baby bf well, but she just could not get comfortable
with bf, and insisted baby needed more. She said to me "I'm going to keep on
with breastfeeding but I'm going to *have* to give her a bottle too." This
mom told me she would bf at nite but would bottle feed during the day. of
course we had talked about the ramifications of this, but this was her plan
and she was sticking to it. On day of discharge, baby had *gained* 3 oz over
birthweight! I gave mom a hand pump to take home (that's all we have to give
at discharge) and instructions/handout on hand expression as well, and
discussed with her re engorgement and such. She does have followup appt in
our BF Clinic. Not sure if that was the right thing, but I felt that it was.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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