When a friend who was about to have her first baby sent me an email with “breast pumps” in the subject line, I figured she was just looking for my usual two cents. Throughout her pregnancy, I struggled to offer just the right amount of information, to share my own beliefs and experience without being dogmatic or judgmental, and to provide honest encouragement, not platitudes. Tricky stuff in the lands of birth and parenting, where a friendly face can be the unwitting minion of those twin demons, fear and doubt.
As I read on, I suspected I had failed to do right by her with past advice, sensing the kind of retribution only bad karma can deliver. It was my turn to be bedeviled. How did a perfectly innocent email about the Pump in Style vs. the Purely Yours turn bad?
If you didn’t hesitate for a second to loan your personal use electric pump to a girlfriend or sister-in-law, you must not have read the warnings from the manufacturers or the FDA or La Leche. Like I didn’t. Turns out that most pumps aren’t designed to be shared, flying in the face of our compulsion as mothers to exchange our tips, our experiences, and our stuff with other mothers. The manufacturer Medela likens a breast pump to a toothbrush, and automatically voids the warranty if you share yours:
“Personal use pumps should never be resold or shared among mothers. The Medela Pump In Style has an internal diaphragm that cannot be removed, replaced, or fully sterilized. Therefore, the risk of cross-contamination associated with re-using a previously owned pump such as the Pump In Style cannot be dismissed, even when using a new kit or tubing.”
What’s the specific worry? Just of infecting our nursing babies and ourselves with bacteria like Staph and Strep, viruses like HIV and hepatitis, and other nasty bits from the realm of the unseen. Apparently, if milk or blood from a cracked nipple were to find its way into the pump’s mechanism, there’s really no way to disinfect it. I figured that if each user bought a fresh collection kit—the tubing that connects to the pump and the plastic parts that touch breast and milk—there would be no problem. After all, hospitals rent pumps to scores of women, and we know they never willingly put themselves in the crosshairs of the litigation gun. But their pumps are designed to be used by many, so can be thoroughly disinfected between users. Not so most consumer pumps out in the world, even the fancy ones. Only personal use pumps from Ameda that include their patented HygieniKit can say they offer any protection. This little part was cleared by the FDA in late 2001 to claim that it protects collected breast milk from potential contaminants in the pump and/or kit tubing and protects pump and kit tubing from potential contaminants present in collected milk.
I knew as much as anyone reasonably can that I wasn’t harboring disease, so my first pump buddy was likely safe. But what about her? She was a new friend, and I couldn’t say with certainty that she had a clean bill of health, or that she could even definitively say so herself. Had I inadvertently exposed my sister-in-law and niece to serious illness, and myself and my new baby, too?
My first thought was to try to find some data on Medline, the National Library of Medicine’s research
tool, with abstracts from a good deal of the world’s medical literature online. A search with keywords “breast pump breastfeeding” yielded thirty-five results. While there was interesting reading on supporting working mothers who breastfeed and the controversy over establishing milk banks in developing countries (among other topics), not one citation answered my question. I next tried “breast pump contamination” as my search terms. Among seven results, there was some discussion of the types of bacteria that can end up in pumped milk, with concern for the health of premature babies in mind. However, still no targeted answers for me. I would have started to feel better in a “no news is good news” sort of way if I didn’t recognize that I might not be asking the right question.
Since many months had passed between the times that each of us had used the pump, I wondered how long any of the viruses, the most troubling in the lot, could live outside the body in a minute, even microscopic amount of bodily fluid. I first thought to hit Google, which has always been a trusty tool for solving mysteries. But the prospect of more rooting around online left me annoyed and unfulfilled in advance, which is when I thought to contact the Center for Disease Control the old-fashioned way. I phoned the CDC, and after several transfers, was surprised to be connected to the resident breastfeeding expert. With a background in public policy and maternal-fetal health, including lactation, she was an informed guide in the wilderness of my guilt and paranoia. The key points from our chat:
1. Yes, there is a theoretical risk, but no cases of cross-contamination have been reported. My own look at the FDA’s database (MAUDE or Manufacturer User Facility and Distributor Experience Database) of voluntary reports of adverse events involving medical devices since 1993 bore this out.
2. Bodily fluids won’t easily enter the pump—you’d have to overfill a milk collection bottle then tip it back into the tubing until the fluid made its way through the small hole where the tubing connects to the pump.
3. HIV does not survive well outside the body, although some bacteria and fungi are better at doing so under the right conditions.
4. If you’ve already shared your pump, don’t stress much about it in light of one through three.
5. If you haven’t, to be on the safe side, don’t … unless you’re somehow utterly certain about health status. In any event, each woman should always purchase her own collection kit.
Of course, I had already re-used the collection kits after sterilizing (I thought) the myriad parts from three separate users. After our talk, I launched another research-as-therapy mission to identify, locate, and replace the suspect parts (promptly and at the best price—got that right at least). Which leads me to the true point of all this gnashing and thrashing …
As parents, we’re responsible for the comfort and safety of our children. Like flight attendants for life, it’s one thing to serve a meal that isn’t tasty and another to let our charges roam around during turbulence. Safety breaches can have minor or devastating consequences, although many things can happen unexpectedly even if our vigilance were flawless. That’s our lot in life as humans, magnified many fold when we care for children. In that true scheme of things, a theoretical risk like a contaminated breast pump falls way down on the continuum of things to worry about. However, this folly of mine did serve a useful purpose. It reminded me again that one of our jobs as parents is to teach our children to live life fully each day, not in impulsive or pleasure-seeking defiance of risk, but in negotiated co-existence with it. Risk, theoretical and otherwise, is here to stay. We don’t have to give this eternal boarder the best bed in our house, but a well-lit corner seems