When I had my first baby, I was all-in on breastfeeding. But with a poor latch, my daughter wasn’t getting enough milk—and I was getting bloody nipples and hours of excruciating pain each day, and late at night. So my zealousness shifted from breastfeeding to breast milk. And that meant pumping: more than 450 hours of it in my first year as a mother. And I’m not alone. For a multitude of reasons, behind closed office, closet and bathroom doors, millions of people every day are hooked up to electric motors, pumping breast milk to feed their babies.
This hidden labor of parenthood can seem, in some milieux, ubiquitous. “The breast pump became this almost indispensable part of what it means to have a baby,” explains Jessica Martucci, a historian of medicine and bioethicist at the University of Pennsylvania.
As of the early 2000s—the last period for which comprehensive stats are available—some 85 percent of breastfeeding Americans used a pump at some point, with many using one multiple times a day. That number has likely increased, especially after 2010, when the Affordable Care Act required electric pumps to be covered by health insurance.
But these relatively portable, double electric breast pumps that make it possible to routinely, remotely provide breast milk have been around for only about 30 years.
Before they arrived in the 1990s—hidden away in discrete, business-professional cases—contraptions for expressing breast milk already had a long and fascinating story, one that stretches back thousands of years. This history reveals a checkered evolution of perplexing innovation, dubious medicine and shifting ideas of parenthood. Today, amidst infant formula shortages, new American Academy of Pediatrics guidelines to support breastfeeding for two years, the repeated failure of efforts like the proposed PUMP Act to safeguard pumping rights for workers and a spate of new laws severely limiting abortion access after the Supreme Court’s overturning of Roe v. Wade, pumping is poised to suck for more people than ever.
The early days of pumping
For most of its history, the breast pump had been used for short-term crises, such as providing milk for an infant too weak to nurse, bolstering milk supply, allowing damaged nipples to heal, treating retracted nipples, relieving engorged breasts to prevent infection, and sustaining lactation when a mother was ill. People devised a boggling range of tools to accomplish these tasks because before safe and nutritious baby formula was widely available, “the failure of breastfeeding was life-threatening to the infant,” writes neonatologist Michael Obladen in a scholarly history of the breast pump.
Some of the earliest milk-extracting devices on record come from Greece, where archaeologists have unearthed ceramic guttae from the 5th century. These vessels were filled with water and placed over the breast. A spout could be opened and closed with a finger to create a gentle vacuum to draw out milk.
By the 2nd century C.E., the Romans had added long straws to allow the lactator or others to provide their own intermittent suction to collect milk in the attached bulb. This elegantly simple design endured for more than a millennia and a half. While excavating the site of a mid-19th century outhouse in Philadelphia in 2013, archaeologists found a delicate glass “breast pipe” of essentially the same model.
In the 1700s, inventors began incorporating early forms of rubber into pumps, giving rise to a new design that looked a little like a bicycle horn—and persisted into the 1970s.
Historically, demand for breast pumps fluctuated with changes in medical ideas and even shifts in fashion. Some ancient Greek physicians incorrectly recommended against feeding newborns the first nutrient-dense milk produced (known as colostrum)—advice that gained even greater traction in 15th-century Europe and beyond. So these rudimentary pumps could help draw it off until more mature milk came in. In the 16th century, when corsets created “an epidemic of flat nipples,” pumps were recommended to help draw them out for better infant feeding, Obladen writes.
With the arrival of early industrialization even lactation was not out of reach of the enthusiasm for mechanization. In a 1774 document, mentioned by Obladen, the director of a German foundling hospital describes a breast pump that used a hand-powered piston to extract milk. This device, however, was particularly problematic: it was “not easily cleaned, given the fact that it also was used as clyster [enema] syringe and cupping glass,” Obladen notes. It also involved a lengthy process. After being suctioned on, the cupping glasses might be left there “from morning to evening,” the 18th-century physician recommended.
Innovations accelerated into the 19th and early 20th centuries. The first U.S. patent for a breast pump was issued in 1854. The design used hand-operated bellows to create suction. Another severe patent illustration from 1910 shows a full-torso device strapped onto a woman under her clothes. In her arms, an infant drinks from a tube that attaches to a breast shield—a device not for medical use but “to avoid any unpleasant and embarrassing situations” while nursing, the (male) inventor noted in the patent as a new era of prudishness swept the country. Brass or pewter pumps that resembled hand bicycle pumps were sold nestled in velvet-lined mahogany boxes.
Despite these many iterations, the breast pump remained “a very impractical device,” says Jacqueline Wolf, a historian of social medicine at Ohio University and author of the book, Don’t Kill Your Baby: Public Health and the Decline of Breastfeeding in the 19th and 20th Centuries.
The pumps often neglected to account for the basic physiology of breastfeeding—or comfort. These devices “never came from somebody whose chief role was thinking deeply about human milk and lactation,” says Michelle Fisher, a curator of contemporary decorative arts at the Museum of Fine Arts in Boston and co-founder of the exhibition Designing Motherhood. They were typically developed by engineers or catch-all “inventors”—and almost always men—rather than birth, health or medical workers.
Feeding extracted milk to babies was also incredibly risky. Before the ascent of germ theory in the late 19th century, inventors put little attention into making pumps easy to clean, which meant they often contaminated milk with life-threatening bacteria. And before reliable, widespread refrigeration in the 1930s and 1940s, there was no safe way to store milk for more than several hours.
Another major reason why all of these pumps weren’t more widespread is that they often weren’t necessary. As cumbersome—and potentially dangerous—contraptions, they rarely seemed like a better option than the timeless method of manual hand expression.
Another safer, more reliable way to feed babies was other lactating people. Women often spent at least a decade or two bearing children (if they survived the ordeal), so frequently family and friends or, for those who could afford them, servants who were currently lactating could help keep babies alive by nursing them.
In the absence of other milk-dispensing humans, over the years, people even turned to animals before tools for lactation issues. (One 1816 book from Europe boasted the title The Goat as the Best and Most Agreeable Wet Nurse.) Goats, sheep and other animals were sometimes used to feed babies directly to avoid potentially lethal contamination of milk in unsanitized bottles. On the other side of the diad, to relieve nursing parents, such as for draining excess milk or even for toughening nipples, young animals such as puppies were often recommended to be applied directly to the breast.
A swelling need for a better breast pump
In the late 19th century, however, the need for expressed breast milk began to grow rapidly. For most of human history, premature infants, who struggle to regulate their own body temperature, died. But the 1880s saw the invention of the life-saving baby incubator. Visitors to Coney Island in Brooklyn, New York, in the early 1900s could pay a quarter to see incredibly tiny premature infants on display in some of the earliest incubators in a beneficent sideshow attraction. These babies, unable to nurse, needed milk, which could come from their own birth parent or other women. At the same time, wet nursing was falling out of favor “as society became more concerned about boundaries between bodies and middle class respectability,” explains Martucci. But women, nurses and doctors were still stuck with the inefficient pumping technology that had been developed centuries earlier.
In 1921, a Prussian chess champion named Edward Lasker was picking up extra money in the Midwest improving rudimentary electric cow milking machines when a pioneering American pediatrician named Isaac Abt approached him. A modified version of Lasker’s milking machine, Abt argued, could be used for humans. The resulting invention, known as the Abt pump, soon found its way into hospitals around the U.S. and beyond.
With a growing proportion of births occurring in hospitals, doctors and nurses appreciated this more efficient way to help extract milk when necessary. But “it was loud, it was large, and it required a nurse there to run it,” Martucci says. And it didn’t offer cycles of suction and release like today’s electric pumps but rather applied continuous, no-mercy suction.
Getting hooked up to one of these early electric pumps was likely an overwhelming ordeal. “People [would have] wanted to have an experience that didn’t seem like they were feeding their breasts into a meat grinder,” Fisher adds.
During World War II, when Europe struggled to get parts for these U.S.-made pumps, a Swedish engineer named Einar Egnell set about designing a replacement—and potentially even an improvement. Egnell worked with a nurse who ran a maternity hospital to get feedback from the mothers there to tweak the design until he hit upon the aspect of pumping that had vanished with the antique pipe-style pumps: intermittent pressure to mimic a baby’s patterns, creating “a pump that was supposed to be more like the sucking of an infant—than milking a dairy cow,” Martucci says.
Kathleen Rasmussen, a retired maternal and child nutritionist at Cornell University, refers to the Egnell pump, with its attention to breastfeeding physiology, as “the Cadillac of breast pumps.” It seemed to weigh almost as much, coming in at about 40 pounds, she notes. Given its heft and complexity, it was used almost exclusively in hospitals. And it seemed destined to stay there.
With the meteoric rise in infant formula use through the 20th century, interest in breast milk tapered off. By 1971, about 76 percent of birth mothers never breastfed their infant, even once. Today, about 17 percent of mothers opt exclusively for formula.
The push for a portable, efficient option
But a crisis was brewing on the horizon. Just as women were entering the paid labor force in record numbers—with more than half working outside the home by 1980—new public health messaging was ramping up, telling families to shun formula and that “breast is best.” “Women heard that, but they didn’t have a way to actualize it,” Rasmussen says. “If you wanted to breastfeed, you had to figure out a way to make it happen,” she says, because broader supports (such as universal paid parental leave) weren’t offered.
This put mothers in a terrible bind. Electric breast pumps remained bulky and primarily hospital-based devices; they could sometimes be rented for home use, but typically for a medical reason. Smaller, more affordable hand pumps could be used elsewhere, but they tended to be not as efficient. Even the manual hand pumps as people know them today, with a handle for squeezing, didn’t take over from the 18th-century bicycle-horn-style ones until the 1980s.
These factors created a serious problem because, as anyone who has ever lactated can attest, if a mother delays expressing milk, even for a few hours longer than usual, their breasts can become uncomfortably engorged—and then can decrease the amount of milk they produce. This is why breast pumps are crucial for maintaining an adequate milk supply if people are away from their nursing babies. And it’s why, over the years of lactating, I’ve found myself having to pump in supremely awkward places, including a coach seat on a crowded airplane and the backseat of a car in a funeral procession. (This same principle of demand-and-supply means that pumping can also be used—in often grueling regimes—to try to increase milk supply.)
In 1988, after enduring excruciating electric pumping experiences, a computer systems supervisor named Elena Grant patented a new style of electric breast pump. It had numerous features to improve comfort, including a maximum suction “to prevent tissue damage” and a way for nursing parents to determine the level of suction. With previous pumps, as she noted in her patent application, “the woman is not completely in control of the operation, a factor which leads to an uneasiness which is undesirable for stimulating the let-down and production of milk.” It weighed seven pounds—exceedingly light for the time—and came with a discrete case in which to carry it.
Although Grant’s White River pump wasn’t widely adopted (potentially due to its steep price, amounting to roughly $2,000 today), another arrived right on its heels that was. The Swiss medical company Medela began aggressively marketing its portable double electric breast pump in 1991. Its still-prevalent “Pump In Style” version for “active and working mothers” arrived in 1996.
The problem today
Today, breast pumps are typically seen as a sort of “efficiency tool.” But pumping requires much more work than breastfeeding or formula feeding. For me, pumping allowed me to provide my daughter breast milk when that otherwise wouldn’t have been possible, medically or logistically. But it also has meant carefully washing pump parts after every pumping session (often at 2 a.m.), worrying about cleanliness and contamination if I was pumping away from home, staying up an extra half hour to wash all of the day’s bottles, mentally juggling when each refrigerated or frozen pumped milk serving (which differ in quantity and qualities throughout the day) would best be offered and—before I figured out the logistics of simultaneously bottle feeding while pumping—spending about 12 hours of every day actively feeding, pumping or managing supplies. At six weeks after birth, when the majority of working birth parents return to the job, most newborns are still feeding about seven times in a 24-hour period. To keep up milk supply, a mother needs to match almost every non-nursing feeding with a pumping session, which also means that many times of cleaning or sterilizing pump parts, managing stored milk safety, and just figuring out where and when to take 20 minutes or so each time to do the actual pumping. On top of caring for a new baby and working, “it can be crazy-making,” Wolf says.
A few incremental improvements have arrived in recent years, including some spendy pumps that are battery operated and others that even fit inside a regular bra. These improvements were spurred, in part, by a 2014 MIT-sponsored hackathon called “Make the Breast Pump Not Suck.” The most convenient models, however, are rarely covered by insurance, leaving most people who use pumps, including me while writing this story and pumping for my second baby, frequently tethered to an outlet.
Historians and feeding experts contest that the current pumping conundrum is not a problem that we can invent our way out of. Sure, it’s helpful to have a pump that is totally portable and can be worn in public, such as by a nurse on shift if they can afford it. And even one that has to be plugged into a wall or car adaptor is a lot better than getting suctioned by a metal plunger that also doubles as an enema syringe. But “the breast pump is not the solution,” Rasmussen says.
Ever since the breast pump became portable, efficient and accessible enough to become a stand-in for breastfeeding, Martucci says, “support for breastfeeding takes the shape of this medical device—as opposed to social or community policies that might give women time and economic support for breastfeeding.”
“Individuals will try to use the tools they have available to them to make their lives work,” Martucci adds. “That doesn’t mean that we can just make this a private issue.”
Maybe it’s time for the breast pump to finally come out from behind all of those closed doors.