OBS Pump Loan
Please note that a copy of this form, including all the links, will be emailed to you. If you have any questions about pump hire or how to return the pump, please email pumps@oxbreastfeedingsupport.org. If you have any questions about breastfeeding or expressing, please email the facilitators at team@oxbreastfeedingsupport.org.
Email address *
Your name *
Your answer
Your full address *
Your answer
Your telephone number *
Your answer
Name of the OBS facilitator who has authorised the pump loan. *
Your answer
Pump Loan information
Pump stocks are very limited. Pumps can be loaned for a maximum of three weeks, in cases of urgent clinical need ONLY. Additional hire charges will be incurred if pumps are kept longer than three weeks. If you need ongoing use of a double pump, they can be commercially hired from:

https://www.ardobreastpumps.co.uk/breastpump-hire

http://www.expressyourselfmums.co.uk/Expressing-breastmilk/ameda-elite-hospital-grade-breastpump.htm

https://www.medela-rental.co.uk

Pump instructions
Ameda Lactaline instruction manual can be found here http://www.proximitesante.be/uploads/products/Manuel%20Lactaline%20anglais.pdf
Expressing information
Please watch this video before using the pump for the first time http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

Information about expressing breastmilk https://www.laleche.org.uk/expressing-your-milk/

Human milk storage https://www.laleche.org.uk/storing-your-milk/

Information and tips for bottle-feeding a breastfed baby https://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/

Paced bottle feeding video https://www.youtube.com/watch?v=YoBVtE6S1dk

Breast pump cleaning instructions
After each use:
1. Remove the tubing (and cap) from the kit; these do not need to be washed.
2. Dismantle the pump kit completely.
3. Carefully and thoroughly wash all parts of the kit in hot soapy water (or in a dishwasher). The small white valve tears easily, so it is important to wash it carefully.
4. Rinse thoroughly with running water and place each part on the upturned lid of the container prior to drying.
5. Dry the kit and the lid of the container on a paper towel or kitchen paper – not on a tea towel or cloth.
6. Place the kit in the clean, dry container and cover with the lid.

Before each use:
1. Remove the lid of the container.
2. Wash your hands thoroughly with soap and water before handling / assembling the pump kit.

Once a day: Wash the container in hot soapy water, rinse and dry on a paper towel. You do not need to sterilise your kits, or any bottles/teats used that are used solely for your expressed milk. You may choose to sterilise if your baby is premature, unwell or has an underlying health issue.

Please confirm that you have read the breast pump cleaning instructions above. *
Required
Breast pump loan agreement
Have you received a breast pump, a power adaptor and an instruction booklet? Please tick all that apply. *
Required
How many disposable breast pump kits have you received? *
What is the letter on the breast pump that you have been given today? *
Your answer
Pump payment
Loan of an OBS pump costs £10 for the first week and £5 per week for the second and third week. If this is not affordable for you, please contact us in confidence: team@oxbreastfeedingsupport.org.

We ask that pumps are borrowed for a maximum of three weeks; if kept for longer than this, the loan charge will be £20 a week up until six weeks. If a pump is not returned within six weeks, then the borrower will be responsible for the cost of a new replacement pump of the same model, in addition to the usual cost of pump loan. (Cost at 13.10.18: £129.99)

Oxfordshire Breastfeeding Support is a charity and receives no statutory or health funding. Our pump loan prices are set to ensure that we are covering the costs of running the pump loan service. If you would like to donate to help protect and support our service, see https://www.oxbreastfeedingsupport.org/index.php/protectobs .

Oxfordshire Breastfeeding Support bank details
Bank: Co op
Account name: Oxfordshire Breastfeeding Support
Sort code: 08-92-99
Account number: 65853917
I have paid for the loan of the pump. *
If you have answered yes to the question above, please tell us how much you have paid. If you have answered no to the question above, please put 0 or N/A to this question. *
Your answer
I agree to pay any outstanding costs of pump loan on return. *
Required
I agree that if I do not return the pump within six weeks, then I will be responsible for the cost of a new replacement pump of the same model, in addition to the usual cost of pump loan. (Cost at 13.10.18: £129.99) *
Required
I understand that while OBS will take all reasonable steps to ensure that equipment supplied is in full working order, sometimes things go wrong. If the pump is not working correctly, I can contact the OBS team and they will arrange a replacement as soon as possible. *
Required
I understand that the bottles that I have been given cannot be guaranteed to be sterile and that I may wish to wash and sterilise them before first use. *
Required
I agree that OBS is not liable for any harm resulting from the use of this equipment. *
Required
Today's date *
MM
/
DD
/
YYYY
Date pump due back to OBS *
Please input the date that is three weeks from today.
MM
/
DD
/
YYYY
Please print your full name in lieu of a signature *
Your answer
A copy of your responses will be emailed to the address you provided.
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