I am benefitting from the discussion and examining what I do and what is
done at my institution.  We do not profit or get salaries from pump
rentals, but the hosp is looking into changing that in the future. This
should give us lots to think about.

In bf classes (prenatal) the moms always bring up pumps and going back to
work at 4 - 6 wks (yikes). I say that unless we get the bf off to a good
start, the need for a pump while continuing bf and going back to work is
moot. So I say call me when it gets about 2 weeks before your return to
work or school and we'll talk about your indiv. situation.

I like hand expression, and do teach it, and do tell the moms they have
to practice and find where their anatomy is and what works best for them.
 I do give out pumps, but not to all moms, only ones that have babies in
nicu or babies not bf well or at all at discharge (unfortunate, but
true). These get followed by phone and in my office. Any couplet that
goes home pumping is not a normal dyad and needs to be followed closely.

On pumps getting much less milk out than the baby (especially first days)
- I say "now look at this pump and flange" (i call it a funnel - they can
relate); "it is one size fits all. Now all  breasts are different and the
baby can milk your breast so much better. So don't expect much from the
pump. "

Laurie Wheeler, RNC, MN, IBCLC