The impossible quest to build a better breast pump

I never thought I’d be excited to try out a breast pump.

My son was born last year, and when I came back to work after 12 weeks of leave, I had to figure out how to write on very little sleep, how to meet all my deadlines in my newly limited time — and how to pump. Like a growing number of American women, I breastfed my baby, and I wanted to continue feeding him breast milk even when I was away from him during weekdays. That meant that I had to use a machine to remove milk from my breasts every three hours.

The process turned out to be difficult, stressful, and time-consuming, costing me precious work hours and isolating me from my coworkers. And I had it easier than most new mothers: I had paid leave in the first place, and an employer that made an effort to be accommodating to pumping mothers.

For the uninitiated, here’s what the pumping process looks like: Assemble five plastic parts into an apparatus that looks a little bit like a trumpet. Take off your shirt and bra and put on a special hands-free pumping bra (not included with the purchase of the pump — you have to buy one or make your own). Fit one end of the trumpet inside the bra and over your breast, and connect the other end to a tube that leads to the pump. Do the same for the other breast. Turn on the pump and leave it on for anywhere from 10 to 30 minutes. Then disconnect, get dressed, put the milk in the fridge, and get back to work.

Did I mention that the Centers for Disease Control and Prevention recommends that you wash each part after every pump session and sanitize all of them in boiling water once a day? Or that many people have to pump three (or more) times during the workday, both to make enough milk for a baby and to maintain milk supply? Or that if you miss a session, you can end up with painful clogged milk ducts or an infection called mastitis that can require antibiotics?

As Jessica Shortall, author of the pumping advice book Work. Pump. Repeat., told me, “the whole thing is painful, ugly, loud, precarious in terms of its operability and dependability, and very exposing.”

Which is why I found myself fitting a Willow pump to my breast one morning last fall. The Willow, a hands-free, tube-free pump, is one of several recent innovations that promise to make the pumping experience better for mothers. Others include the Elvie Pump, billed as “the world’s first silent wearable breast pump,” and accessories like the Hush-a-Pump Case that aim to fix various problems with pumping.

Amanda Northrop/Vox

But as I learned, the problem facing parents trying to feed their babies goes far beyond the pump. The American Academy of Pediatrics recommends that infants get breast milk exclusively for the first six months of life, and though the science of breastfeeding is controversial, it’s been increasingly promoted in recent years as the healthiest way to feed a baby.

However, nothing in American society — not parental leave policies, medical care, research funding, work culture, or product design — is set up to help parents feed their children breast milk. Changing that will require reimagining not just the pump itself, but the entire culture around work and family.

Pumping is terrible. Here’s why.

Here are some of the complaints Shortall has heard from women: Breast pumps are noisy, easily heard on a conference call or through a thin office door. The flanges — a term for the cone-shaped pump part that goes over the breast — can leak, leading to embarrassing stains on work clothes. Even without leaks, the process looks bizarre; one friend of Shortall’s told her his wife’s nipples in the pump looked like “thumbs in a garden hose.”

Pumping isn’t supposed to be painful, but it can be, especially if your flanges don’t fit properly. I took a portable pump on a work trip recently, and as a TSA agent swabbed it down for drug residue, I heard another agent mutter to her male colleague, “That shit hurts.”

It’s also a time suck. In total, I spent about 90 minutes a day pumping, and though I could type on my laptop during some of that time thanks to the hands-free bra I purchased, I was still losing hours every week assembling, disassembling, and cleaning tiny parts — hours I could have spent working, playing with my baby, talking to my husband, or catching up on much-needed sleep.

Given the loss of work time, it’s no surprise that pumping may harm women’s earning power — a 2012 study found that mothers who breastfed their babies for at least six months suffered a greater drop in earnings after having children than moms who didn’t breastfeed, as Rebecca Greenfield reported at Bloomberg. And even if you, like me, can type while you pump, you’re still alone in a lactation room, missing out on potential networking opportunities and the intangible benefits of actually seeing your colleagues.

As Eleanor Barkhorn wrote for Vox, breastfeeding is often touted as an inexpensive way to feed your baby, “but that’s only true if you assume your time has no value.” When I was pumping, it sometimes seemed to me that breast pumps had been designed by people who assumed mothers’ time had no value.

I felt grateful to be able to make milk for my baby and still keep my job, especially when so many women have to choose between the two. A space for pumping like the one I used at work is required under the Affordable Care Act for many employers, but fewer than half of mothers have access to one, according to a 2018 study. I also have a fair amount of control over my schedule and, unless I was traveling for a story, could relatively easily block off time to pump — which is not the case for many police officers, teachers, nurses, or others whose careers involve a lot of face time.

Javier Zarracina/Vox

Still, I kept wondering why pumping had to be so difficult. The reasons, it turns out, are many. For one thing, the process of breastfeeding is complicated. Breasts and nipples come in many different shapes and sizes, and it’s important for flanges to fit properly, said Kathleen Rasmussen, a professor of maternal and child nutrition at Cornell University.

And there are a lot of things we don’t know about pumping — like how pumping compares to breastfeeding in terms of how much milk a mother produces, and how dangerous it is for women to pump using non-sterilized parts.

Human milk is an “absolutely terrific growth medium for bacteria,” Rasmussen explained — and if pump parts aren’t cleaned properly, they can introduce bacteria into the milk. But it’s not really clear how dangerous that is. “Women are not reporting sick children from the use of their pumps in great numbers, so how big this effect is, we really do not know,” she said.

We don’t have answers to such questions in part because of a dearth of funding for research, Rasmussen said. There’s a “lack of investment on the part of the government in finding out what’s in the fluid they encourage us to feed our babies,” she explained.

In addition to these barriers to learning more about breastfeeding and pumping, there may also be societal obstacles getting in the way of better breast pumps.

US Patent and Trademark Office

The devices were first patented the mid-19th century, as Megan Garber wrote at the Atlantic in 2013, and were typically meant to help feed babies who had trouble nursing. But in the 1990s, relatively affordable electric pumps for home use became available, and breast pumping rates began to climb. Between 2005 and 2006, 85 percent of breastfeeding mothers of healthy single babies had expressed milk from their breasts, as Jessica Martucci, a research fellow at the Science History Institute in Philadelphia, wrote in the American Medical Association Journal of Ethics.

Pumps enjoyed another surge in popularity after the 2010 passage of the Affordable Care Act, which mandated that insurers cover the cost of a breast pump. The market for pumps has been growing steadily ever since, and reached $891.5 million in sales worldwide in 2016. As of 2015, Americans made up about 40 percent of the global demand for pumps.

Despite their growing popularity, breast pumps have been relatively slow to change. “In general, technology companies have not innovated in terms of technology for women,” said Tania Boler, the CEO of Elvie, which introduced a wearable breast pump in the US earlier this year. Tech companies are often led by men, who may not be up to speed on issues in women’s health, she said. Moreover, “there’s this assumption that women are not early and avid adopters of great technology.”

“There is a history of products for women being thought of as a ‘women’s thing,’ rather than as a great business opportunity or a public health problem to solve,” Shortall said. “If it affects primarily or only women, it’s not considered everybody’s problem.”

New breast pumps may be the beginning of a solution — for some

When I first heard about the Willow — through an ad on Instagram, which I spent a lot of time scrolling through during middle-of-the-night feeding sessions — I was intrigued. It seemed to offer a far more seamless pumping experience than I was used to. You wear the Willow inside your bra. All the pump parts are contained within the device itself, which is roughly the size of half a softball.

Once it’s attached, the company promises, you can walk around, do chores, even work in an office, all while pumping milk. “Mobile. Quiet. Spill-Proof. Trusted,” the Willow website proclaims.

The Willow was created to give pump users not just mobility but “a little bit of dignity,” Naomi Kelman, the company’s CEO, told me. “You shouldn’t have to undress to do this, or wear a cumbersome bra that has dangling baby bottles.”

When I tried a Willow for this story (Vox Media covered the cost), some aspects were appealing right away. Once I got both devices (you have to buy one for each breast) latched and pumping, I could stand up and walk around at will. And Willow was attractive — a smooth white half-orb with sky-blue accents. “Mom input has been integral at every step of Willow,” Kelman said. Mothers asked the company to produce the device not in flesh tones but in “beautiful neutral colors” (in addition to white, Willow comes in gray).

Slipping the Willow into my bra, I felt like someone cared enough to make something nice for me.

However, there were downsides. The Willow was not particularly discreet. The device is large — even under baggy clothing, it made me look a bit like a fembot from the Austin Powers movies. I would not have been comfortable wearing it at my desk or in a meeting.

And the Willow hurt. At first it was just discomfort, but by the third pumping session of the day, I was in enough pain that I was too distracted to work. My nipples emerged from the Willow swollen, misshapen, and disconcertingly white.

During a FaceTime coaching session — included for free with Willow — a helpful coach determined that my nipples were probably too small for the flange I was using, resulting in painful chafing.

Unfortunately, Willow does not currently make a smaller flange, though the company plans to roll out additional flanges in the second half of 2019, Kelman said.

And there’s another issue with Willow: the cost. Willow retails at $479.99 to $499.99, about $150 more than the popular Medela Pump in Style. The pump also requires specialized bags, which cost $11.99 for a shipment of 24 — a significant added cost, since many other devices allow users to pump into reusable bottles. The Willow isn’t yet covered by insurance, though Kelman says the company is working with insurance providers to negotiate coverage. Willow also offers an installment plan to allow customers to pay off the cost over time, and some customers use health savings account money to pay for the pump and bags, she said.

I ended up seeing the Willow as a step in the right direction. But because of the cost and the fit issues, a lot of people won’t be able to take advantage of its convenience. And for many women, the problem with breastfeeding in America today starts before they ever try out a pump.

Around the country, experts are working to “hack” breastfeeding

The Willow isn’t the only solution out there to problems people face while trying to pump. The Elvie Pump, another wearable option, made an appearance at London Fashion Week in fall 2018 — the pump sold out its first production run in the United States in February, and Elvie expects to have more available in April. Unlike Willow, the Elvie allows users to pump into reusable bottles. It also comes in three flange sizes.

Meanwhile, MIT has twice hosted a Make the Breast Pump Not Suck hackathon devoted to improving parents’ experiences pumping and breastfeeding. The first event, in 2014, generated ideas like the Mighty Mom utility belt, a hands-free, wearable pump; and Second Nature, which imitates the movement of a baby’s tongue. (Neither made it to market, but members of the teams involved later developed the Hush-a-Pump noise-muffling case and the Pump2Baby bottle.)

Courtesy of Make the Breast Pump Not Suck

Courtesy of Make the Breast Pump Not Suck

When the team was planning the second hackathon, which took place last year, they aimed “to not just hack the device itself, but the systems, programs, and culture around breastfeeding and pumping,” said Rebecca Michelson, who served as the project manager for the 2018 event. The second hackathon, which had over 250 participants and sponsors including breast pump manufacturers Medela and Lansinoh, also focused especially on ideas to help low-income mothers and mothers of color, who face additional obstacles to breastfeeding and pumping.

“You have to initiate breastfeeding to even get to the pump phase,” said Anjanette Davenport Hatter, the executive director of the Harambee Care Maternal Infant Health Program, which provides home visits to Medicaid recipients with new babies in Detroit. The people Harambee Care serves, often low-income women of color, sometimes face bias from doctors and nurses, Hatter said.

There’s a preconceived notion that “people of color don’t care — they don’t care about their health, and they sure don’t care about what’s beneficial for their babies,” Hatter said. So low-income mothers of color may get offered formula for their babies when it isn’t medically necessary, or face the assumption that they’re not interested in help from a lactation consultant.

A team from Harambee Care worked on this problem at the 2018 hackathon, and created “My Lactation Plan,” a resource to help mothers, families, and health care providers work together to support breastfeeding. The team was one of several award winners at the hackathon.

And because a lack of paid time off is at the root of many parents’ problems with breastfeeding and pumping, the event also included a policy summit dedicated to ideas for improving access to family leave.

One night while I was reporting on this story, the train I usually take home from work was delayed, causing me to miss my son’s bedtime. This meant that instead of spending time with him and my husband when I got home, I had to go to the bedroom and hook myself up to a breast pump. As I prepared to spend my first free time after a long workday strapped to a machine, then cleaning and sterilizing its many parts, I was reminded again that the pumps themselves are only a symptom of the bigger problems women face when they try to breastfeed and work.

Since the 1990s, more women feel pressure to breastfeed, but there have been few policy changes to really help them do so, Martucci said.

“Instead of compensating women for time spent off from work while they exclusively breastfeed in paid maternal leave policies,” she said, “we’ve seen the government subsidize breast pumps and require lactation rooms in workplaces — these are policies that don’t actually do much to change how society treats mothers and babies.”

For many parents, guaranteed paid leave would lessen the need for prolonged breast pump use. Other countries recognize that the time women spend breastfeeding “is a tiny portion of their lifetime as productive workers, and their benefits reflect that,” Rasmussen said. “For some reason, we seem not able to do that same calculus.”

Absent a larger conversation about paid leave, some cultural changes might be necessary to make breast pumping suck a bit less. One possible change is suggested in Willow’s marketing materials. They show women using the device in public — one conducting a meeting, another waiting for a bus. I felt too self-conscious to wear the Willow outside our office’s lactation room, but that feeling was influenced in large part by our culture’s attitudes toward breastfeeding and pumping. If pumping were seen as a normal thing to do, I might have been more comfortable doing it in front of my coworkers.

Kelman told me that last year, model Nicole Phelps, wife of Olympian Michael Phelps, posted an Instagram photo of herself using the Willow under her evening gown at a gala for her husband’s foundation.

Phelps got criticism for pumping in public, Kelman said, but moms flocked to her defense on social media. “Just this outpouring of intensity of emotion around it shows that women feel this needs to change,” Kelman said.

Better breast pump technology could be part of that change. But as Martucci points out, the rise of breast pumps hasn’t altered the fact that “the burden for infant care and feeding falls almost exclusively upon mothers.” To make the experience suck less, that burden will have to shift.

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