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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome