Key takeaways: Choose a pump based on how often you’ll use it. Double electric pumps are best for regular pumping. A well-fitted flange lets your nipple move freely without rubbing or pulling in lots of areola. Start suction low and increase to comfort, never pain. Most U.S. insurance plans cover a breast pump.
Whether you’re returning to work, building a small stash, or exclusively pumping, the right equipment makes a big difference. Many pumping problems, from pain to low output, come down to flange fit and settings.
Types of Breast Pumps
- Hand expression: no equipment needed. Especially useful for colostrum in the first days.
- Manual pumps: inexpensive and quiet. Good for occasional use.
- Silicone collectors (passive pumps): catch letdown from the other breast while you nurse.
- Single or double electric pumps: good for regular pumping. Double pumping saves time and may increase output.
- Wearable pumps: fit inside a bra for hands-free pumping. Convenient, though some people find them less effective as their only pump.
- Hospital-grade (multi-user) rental pumps: powerful pumps for establishing supply when a baby can’t breastfeed, such as with a NICU stay.
Insurance Coverage
Under the Affordable Care Act, most health insurance plans must cover breastfeeding support and equipment, including a breast pump. Coverage details vary, so call your insurer during pregnancy. WIC programs may also provide pumps.
Flange Fit Matters
The flange (or breast shield) is the funnel-shaped piece that fits over your nipple. A poor fit can cause pain, nipple damage, and poor milk removal.
Signs of a good fit:
- Your nipple moves freely in the tunnel without rubbing the sides.
- Only a small amount of areola, or none, is pulled into the tunnel.
- Pumping is comfortable and your breast feels softer afterward.
Signs the flange is too small:
- The nipple rubs against the tunnel walls.
- Pain, redness, or blisters on the nipple.
Signs the flange is too large:
- A lot of areola is pulled into the tunnel.
- The nipple swells or becomes painful.
- Pinching at the base.
Measuring: many brands suggest measuring the diameter of your nipple (not the areola) at its base, in millimeters, after pumping or nursing, then choosing a flange a few millimeters larger. Many people need a smaller flange than the standard size that comes in the box. Sizes can change over time, and each side may need a different size. A lactation consultant can help with fitting.
Inserts: silicone flange inserts can make a flange smaller and more comfortable.
Settings That Help
Most electric pumps have two phases:
- Stimulation (letdown) mode: fast, light suction to trigger letdown.
- Expression mode: slower, deeper suction to remove milk.
Tips:
- Start suction low and increase slowly to the highest comfortable level, then back off slightly. More suction isn’t better if it hurts, and it can damage tissue.
- Switch back to stimulation mode if milk flow slows, to trigger another letdown.
- Hands-on pumping: gentle breast compression while pumping, then hand expression afterward, can increase output.
Cleaning Pump Parts
Wash pump parts that touch milk after each use in hot, soapy water or the dishwasher (if the manufacturer allows), and let them air-dry. Sanitize at least once a day for babies under 3 months, premature babies, or babies with weakened immune systems. If you’re refrigerating parts between sessions to save time, discuss this with your provider; the CDC recommends cleaning after every use.
Getting Help With Letdown
- Look at a photo or video of your baby, or smell a piece of their clothing.
- Relax your shoulders and take slow breaths.
- Apply warmth briefly before pumping.
- Cover the bottles so you don’t watch ounces.
Call your provider if: pumping causes ongoing pain, nipple damage, or bleeding; you develop a red, painful area on your breast, fever, or flu-like symptoms; or your output drops suddenly and doesn’t recover.
The Bottom Line
Choose a pump that fits how often you’ll use it, check your flange size, and set suction to comfort. Pumping should never hurt. A lactation consultant can troubleshoot fit and output.
My book, From First Breath to First Birthday, includes pumping plans for work, exclusive pumping, and building a stash.
Sources
- Becker GE, Smith HA, Cooney F. Methods of milk expression for lactating women. Cochrane Database Syst Rev. 2016;9(9):CD006170.
- Morton J, Hall JY, Wong RJ, Thairu L, Benitz WE, Rhine WD. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol. 2009;29(11):757-764.
- Prime DK, Garbin CP, Hartmann PE, Kent JC. Simultaneous breast expression in breastfeeding women is more efficacious than sequential breast expression. Breastfeed Med. 2012;7(6):442-447.
- Centers for Disease Control and Prevention. How to keep your breast pump kit clean. https://www.cdc.gov/hygiene
- HealthCare.gov. Breastfeeding benefits. https://www.healthcare.gov/coverage/breast-feeding-benefits/
- Meek JY, Noble L; Section on Breastfeeding. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2022;150(1):e2022057988.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
