I have 12 v plugs in my car would this still work for my 9v medala pump?

Yes. This adapter can be used with most 12v car lighter outlets,And the output is 9v,So you can use it for your 9v pump.

Do you find that the pump is weaker when using this compared to the regular wall plug?

Yes, I ended up pumping 50% longer, and only received 50% of my normal pumping output.

Does this work for ameda pump?

It works for my Ameda Finesse pump

Does my car have to be on for it to work?

Some cars do, some cars don't... *All car batteries will go flat if you run them out with the engine turned off*

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