Breast pump use among Maryland WIC mothers: Implications for education, distribution, and breastfeeding success

Introduction: The Maryland WIC program supports breastfeeding through various methods, including peer counselor education and support and distributing breast pumps. WIC recommends against pump use until infants are three weeks; however, many clients begin pumping soon after giving birth. Using qualitative analysis, we identify causes and consequences of early pump use. Design: A convenience sample of 55 mothers with infants was interviewed at five geographically representative Maryland WIC clinics. In addition, 7 WIC breastfeeding peer counselors were interviewed about clients' pump use. Preliminary Results: Women's most common reasons for pumping are to allow others to feed the baby, to use bottles of pumped milk in public, and to mitigate breastfeeding difficulties. Many women have concerns about milk supply even when their babies gain adequate weight and produce an appropriate number of wet diapers. Discussion: Maryland WIC distributes pumps to clients who are employed or in school. Quantitative studies of pump distribution in other states' WIC programs indicate that pump receipt furthers breastfeeding duration. However, our findings show that clients who begin using a pump soon after birth usually discontinue breastfeeding long before returning to work or school. Most breast pumps do not provide enough suction to establish a milk supply. Indiscriminate pump use can cloud perceptions of milk adequacy, cause pain, and undermine confidence. Using bottles in an infant's early weeks can lead to nipple confusion. These findings may have relevance beyond the WIC population. WIC's breastfeeding peer counselors and others should consider expanding education specifically regarding pumps to include more information about delaying use, proper use, and reasonable expectations about milk production.