It's always interesting following the discussion about what pump to use to
maintain supply when baby is not able to do any feeding at the breast.
Mainly I am fascinated by the range of products available to many of you.
Where I live there are some Ameda pumps being loaned from well child clinics
at no charge apart from the collection set (purchased by mother), and one
business that rents  Medela Symphony pumps.  The well child clinic is where
care of all children takes place for the first 18 years, and school nurses
are part of the staff there.  This means that a school doesn't have its own
nurse, but uses the school nurse(s) employed at the well child clinic in the
school's geographic district.  Children with chronic conditions requiring
other care will have that care coordinated through the well child clinic.
Only rarely does a child have its own pediatrician, but they all have a
named PHN at a well child clinic.

In larger towns and cities, women generally have to rent pumps.  In smaller
communities where there aren't enough people to keep a pump rental business
alive, the well child clinics will have a number of pumps available to lend
as needed.   The good part is that everyone has access, but the bad part is
there isn't much choice.  I've not seen more than one flange size, since
Ameda took out the extra flange that you could place inside their standard
flange, about 5 years ago.

The most interesting thing to me, however, is that when mothers are being
followed in my clinic, which is hospital based and offers continuing care
for more difficult breastfeeding problems as long as necessary, they
occasionally pump while at the clinic, and almost without exception they
prefer our pumps over the newer ones.  Ours, according to the Medela sales
staff, should have been consigned to a museum, or worse, decades ago.   I
can see why they'd like that; these prototypes from the fifties are still
going strong, the noise they make is soothing to the ear, and they are so
funky-looking it makes you laugh just to see one, and when mothers can
compare, the modern versions don't seem to measure up.  This isn't retro
design, it's vintage design!  They are so much simpler to set up than the
Symphony, for example, and the Symphony has that wimpy high-frequency low
intensity fluttery suck stuff when you turn it on, with a kind of panting
sound reminiscent of an obscene phone call, that most of the mothers I see
just skip altogether, since they are used to expressing by hand until the
MER occurs, and then applying the pump.  Takes a lot less time and is more
comfortable.

Women who shop for a personal use pump now are strongly encouraged by
salespeople to invest in an electric version rather than a manual.  I advise
against it, as they cost at least twice what a manual pump does, and the
reports I am getting from mothers are that they don't work as well as the
manual versions from the same manufacturers, particularly the Avent model.
If they insist on buying a manual pump they need to really stick to their
guns.  The sales pitch is definitely not soft sell, as companies realize
that young parents have surprisingly deep pockets and are very willing to
delve into them if they think it will help their baby.

For the record we don't advise women to buy a pump at all, and emphasize
that they may never need one.  My bias is that if they really truly need a
pump, as when baby is born in week 28 and unlikely to feed fully at the
breast in the near future, they are better served by borrowing or renting a
better caliber machine for the duration, and then divesting themselves of it
when it is no longer needed.  Easier to see it as a temporary, technical aid
than as part of the whole motherhood package.  If baby is hospitalized for
longer than mother, the rental fee is covered by the National Health.  

Rachel Myr
Kristiansand, Norway

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