Remember even expert opinion is a level of evidence. RCT's are a higher 
level of evidence, but we don't have them. I would love to have head to 
head trials of the different pumps in the same mother (a cross-over 
design) to see what's most effective. Perhaps once the FDA must approve 
breast pumps as safe and effective there will be money to do so.

My own experience based on 19 years of clinical practice is that while a 
few mothers can initiate and maintain milk production with consumer 
grade pumps, most do not manage over time, and switching them to the 
piston driven hospital grade pumps makes a huge difference in helping 
them recover and maintain supply. Human beings are complicated, and no 
one pump works well for every mother, but we do see a difference in 
supply in our practice when we work with moms and babies over time spans 
of months or years.

Catherine Watson Genna, BS, IBCLC  NYC

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