Cover Story

Building a Better Breast Pump

From “Smart” pumps to new compression devices, engineers are re-thinking this essential piece of equipment

Right now thousands of women are connected to a machine. This machine is essentially a vacuum, but these women aren’t housecleaning: they’re pumping breast milk for their babies.

Breast pumps are important pieces of equipment for new mothers. Both the World Health Organization and the American Academy of Pediatrics recommend that babies receive breast milk exclusively for their first six months. There are many benefits to feeding babies their mother’s breast milk—including, for the baby, lower risk of asthma, obesity, and type 2 diabetes and, for the mother, a reduced risk of ovarian and breast cancer.

Breast pumps help make these benefits possible. “The breast pump is a tool that enables a mom to maintain her milk production so that she can continue to breastfeed her baby when she is with her baby,” says board certified lactation consultant and pediatric nurse Nancy Holtzman. “And she can prepare and provide the best food in her absence, which is her expressed breast milk.” Breast pumps are also potentially life-saving devices for premature or ill infants who are unable to feed directly from the breast, and who especially need breast milk’s antibodies and nutrients.

However, unlike other machines that people use daily—cell phones, cars, and yes, even vacuums—breast pumps have seen very little innovation in the past few decades, likely because this is one technology used exclusively by women. And there is definitely room for improvement.

Pumps have many parts that need to be assembled, disassembled, and cleaned for each pumping session. They are loud and complicated. They are billed as ‘one-size-fits-all.’ “What if we just manufactured size 7 shoes?” asks Holtzman. “It would work really well for a bunch of people and it would work kind of ok for people with smaller feet and bigger feet—they could manage—but for a bunch of people it’s just completely inappropriate.” And they are not terribly efficient. A mother working an eight-hour work day may spend up to an hour and a half pumping; a mother of a baby in the NICU may spend four hours or more. All these reasons mean that many women decide not to pump when they return to work or school. Many decide to wean their babies instead.

But breast pumps may be primed for improvement. On a fall weekend in 2014, the Massachusetts Institute of Technology’s Media Lab held a ‘Make the Breast Pump Not Suck Hackathon’ where 150 healthcare providers, engineers, designers, and parents joined together to try to address these challenges. “Our goal is to pick this industry, wake it up, and make sure it innovates,” says Tal Achituv, a research assistant who helped organize the hackathon and is spearheading several ongoing pump-related projects through the Media Lab.

Everything old is new again

The most popular type of breast pump for most mothers is a double electric vacuum pump. The pump works like this: A flange sits on each breast. A vacuum draws the nipples and areolas into the tunnel of the flange, compressing the breast tissue and ejecting the milk. Rethinking this model is one of the starting points for breast-pump hackers.

One of the most innovative ideas presented at the hackathon was a prototype of a pump called ‘Compress Express’ that works in a different way. The pump is the brainchild of Susan Thompson, CEO of Kohana Inc., and the idea behind it is relatively simple. It uses an air bladder—like those in blood pressure cuffs—to gently compress and release the breast without relying on a vacuum. Designing a compression pump hasn’t been easy. “The breast is a challenging shape to compress and not have the forces counteract each other,” says Thompson. “Being creative about the shape of the air bladder, that’s been the big innovation of our design.”

Susan Thompson and her family.

Susan Thompson and her family.

Another challenge is that breasts come in all different sizes. So far Thompson has tested her pump on about 30 mothers. “We’ve been able to test a wide range of sizes by just using a couple different sized air bladders,” says Thompson. “We have a good sense of how we can accommodate a really large range of sizes—about 90 percent of women—with three sizes, maybe four.”

One major benefit of the Compress Express pump is that it is designed to be much quieter and more discrete than a standard vacuum-based pump. “This would allow women to pump in places where other people are—in the airport, at their office,” Thompson says. In fact, she says, her pump is 20 decibels quieter than commercially available pumps.

Thompson has been working on her design for the past two years. The inspiration for her compression-based pump is hand expression. Women used hand expression before pumps were invented and continue to do so today when they need to express milk and don’t have access to their baby or a pump.

While there is not a lot of data on how a compression-only pump would fare in a head-to-head competition with an electric vacuum pump in terms of efficiency, studies of hand expression may provide some insight. A woman can use hand expression to remove colostrum—yellow, antibody-rich, viscous milk produced during a baby’s first days—which is especially important if her baby is too premature or ill to breastfeed. Removal of colostrum is crucial for making breastfeeding possible down the line. “Your future milk production depends on the very early frequent and effective removal of colostrum within the first three days,” says Jane Morton, clinical professor of pediatrics at Stanford. “No study shows pumps are statistically more effective or have better outcomes than hand expression for colostrum expression in the first three days.”

In her own work, Morton has shown that when women use their hands to manually compress their breasts while also using a vacuum pump, their yield is higher than in women who use a pump alone. The milk ejected is also high in fat—including the polyunsaturated fats that are important for the development of the baby’s nervous system. She thinks this might be because this fattier milk is more viscous (similar to colostrum) and requires massaging to remove. So called ‘hindmilk’—the milk removed at the end of the expression or feed—is more fat-rich, suggesting that this technique leads to more complete emptying of the breasts.

Hand compression may also prevent the retrograde flow of milk back to the milk secreting spaces, called alveoli, which happens when breasts aren’t completely emptied during a nursing or pumping session. When such retrograde flow does occur, it signals to the breast to decrease milk production. By removing the small volumes of remaining milk, women who use compression are signaling to their bodies to increase milk production. Maintaining milk production can prevent women from prematurely stopping breastfeeding when they go back to work. “One of the most common reasons that mothers who go back to work discontinue their breastfeeding efforts is that their milk production volume goes down,” says Morton. “They blame it on stress and blame it on their workload, but it may just be the simple fact that they are using an inadequate way of expressing their milk.”

Studies will be needed to see whether a compression pump or even a compression-vacuum pump can be as effective as Morton’s ‘hands on’ pumping technique. “Your hands can do a lot more than a machine,” says Morton. “I think what we’re trying to do with technology is design some machine that will take the place of one’s hands. But I think that will be pretty tricky.”

Making pumps smarter

Gala pump prototype.

Gala pump prototype.

“We really feel like there’s a huge outcry for better technology, especially for moms that are transitioning back to work,” says Janica Alvarez, a judge at the hackathon and co-founder of consumer medicine start-up Naia Health, a hackathon sponsor. “The hackathon was an incredible experience. We were able to bring together a lot of people dedicated to solving this problem.”

Alvarez was especially intrigued by the wearable pump ideas, like Compress Express, that were presented during the weekend. Her company Naia Health, based in Silicon Valley, is working on a different way of rethinking the breast pump by creating a ‘connected’ pump. This pump is controlled by a smart phone. “A lot of moms question their ability to express enough milk,” says Alvarez. “Through our technology moms will be able to automatically track how much they’re expressing each pumping session.” Alvarez says a pumping mother will be able to overlay this information with lifestyle data such as how much sleep she is getting or how much water she’s drinking.

Alvarez says that this pump, which uses both vacuum and compression, contains “radically new technology” and is smaller and quieter than existing pumps, while having hospital-grade strength. It also features redesigned flanges. She hopes to launch the breast pump in the U.S. this year.

Hackathon organizer Tal Achituv is also working on making pumps smarter. Achituv, along with his colleagues and students, is developing a user interface for traditional electric vacuum breast pumps that will make pumping less anxiety-producing. “We’re trying to move a lot of the cognitive load off the mother,” says Achituv. The pump interface asks the mother two questions: Are you pressed for time or not? How comfortable are you? Thanks to a sensor in the flange, the pump knows whether or not milk has started to flow and can learn to optimize pumping speed and strength for an individual mother. “The pump learns you, but the pump also puts all the data on the cloud anonymized,” says Achituv.

This information can also be communicated to a lactation consultant if a woman is having problems, and there are self-help and community resources integrated into the user interface. In the future, aggregated data could be used for research studies. “If we had even 200 women pumping and that data got sent back, we would learn a lot,” says Achituv.

One size doesn’t fit all

“Mothers use breast pumps for a lot of different reasons and at different points in lactation,” says Paula Meier, professor of pediatrics at Rush University Medical Center in Chicago. A good pump should be able to replicate what a baby would be doing at a given point in lactation.

Meier has worked with Medela, one of the market leaders in breast pumps, to test different sucking patterns that mimic how a baby nurses at a particular point in lactation. “I think this is going to be the future of breast pump technology,” says Meier, “It’s going to be having a pump that’s much closer to what a mother’s individual baby would do in the baby’s absence.”

Some of the women at the hackathon wanted to redesign a breast pump to also sound, smell, and feel more like a baby. “There was a vocal group of women at the hackathon who wanted to humanize the pumping experience,” says Holtzman, who was also a judge at the hackathon and is a contributing consultant to the Media Lab. “They wanted to make the pump a softer, sweeter, cuddlier breast pump.”

On the other hand, Holtzman says there was another set of moms who said they didn’t want that at all. “They want to sit down and let their pump do the work; they don’t want to bond with their breast pump.” This highlights another important theme that came out of the hackathon. “Everybody’s different,” says Holtzman. “That’s why I don’t think we’ll ever have a pump that’s truly a one size fits all.”

“The goal of the hackathon was really to bring the conversation to the table,” says Holtzman. And that it did.