When you think about having a baby, or think ahead to breastfeeding, you don’t automatically go right to images of pumping. You don’t picture yourself sitting at your work desk, or up at night listening to the whirring of the machine in an otherwise (hopefully) quiet house. Pumping, like feeding at the chest, can come with its own set of issues and challenges. Hopefully at the end of this blog you have a better understanding of why you should pump, when and how often you should pump, and when to see your lactation consultant.
This has been a pretty difficult blog post to write. There are so many scenarios that could lead a person to pumping I could never share all that I’d want to tell you in one blog post. You could choose to exclusively pump for personal reasons, there could be issues with baby’s ability to latch so a medical need to pump, there could be a low supply issue, or baby could be in the NICU. You could be preparing to go back to work, or already back to work and having issues managing. Maybe you are inducing lactation for a baby you are adopting or a partner or surrogate is birthing. You could be really tired, and touched out, and just need a break.
I could never possibly write enough to cover all situations. Since there are so many different circumstances that could have you ready to pump, I decided to instead write a blog with loads of pumping tips. Take the tips that work and apply to you. If you have some tips I didn’t share here please leave them in the comments for others to read! The biggest take away from this post is that if you are pumping and having an issue it is SO SO IMPORTANT to have an IBCLC on your care team. A consultation is a quick, easy way to make sure you are off to a good start or staying on the right track.
Baby is here! When should you start pumping?
Generally speaking, if feeding at the breast/chest is your goal and that is going along without issue you should not begin to pump until 4-6 weeks post partum (FYI the Haakaa is a pump when suctioned on!). This will give your body and baby time to communicate how much milk is needed to feed your baby. After that initial 4-6 weeks if you want to begin pumping you can do so. I recommend having about 20-30 ounces in the freezer as an “in case of emergency stash” and a safe way to collect this is to pump 1-2 ounces total once or twice a week. Some prefer to use a milk catcher or manual pump and use it on the opposite side while a baby nurses, some people prefer to use a double electric pump to collect this amount. However you choose, just be sure you do not collect more than what is recommended as you could create an oversupply which will come with its own set of issues.
So you’re trying to nurse… but it’s not going well…
If nursing at the breast/chest is not going well, your first goal is to feed your baby. As soon as you suspect an issue you should be contacting your lactation consultant and pediatrician. When I receive a call I first and foremost ask questions to gauge if baby is getting enough to eat. How old is your baby? How is diaper output? How often and for how long is baby nursing? Is there anything else signaling an issue with nutrition or dehydration? If you need to supplement, you can pump and feed baby by bottle. The amount is dependent on term and size, so again contact your lactation consultant and pediatrician to be sure you are feeding the proper amount.
Your second goal is to preserve supply. If your baby is not latching and transferring well, or unable to latch at all you should pump every 2 hours with one 4-5 hour stretch overnight. Some people respond really well to the pump, so do not encourage oversupply by pumping until the milk stops flowing. You want to pump for amounts. So if you’re pumping every 2 hours you should collect about 2 ounces, maybe 3 total sometimes as a buffer. If you are not responding well to the pump yet and are unable to collect that amount you should pump for about 20 minutes total even if nothing is coming out. Shutting the pump off because you think your breasts are “empty” will just cut of the signal to your body to make more milk.
Your third goal is to work on breastfeeding/chestfeeding if getting baby to your chest is the goal. This is where your lactation consultant comes in and I always recommend an in person home visit for these types of cases.
In the meantime, do lots of skin to skin. It’s great for your supply, it’s great for baby, and it’s great for you. It is so beneficial during this fourth trimester.
How do I use this pump?!
The manufacturer of your pump should have tutorial videos or links on their website to get your pump set up for use. Once it is assembled, check the fit of the flanges. Your nipple should not be rubbing the sides of the flange. You should not feel any pinching or discomfort. If you do the flange is too small. If your areola is getting sucked into the flange and you have swelling or a red ring around your areola your flange is too big. Again, it should feel comfortable. If you have any discomfort or damage while pumping you either have a poor flange fit or your suction is up too high. If you are not collecting any milk you may have a poor flange fit. Adjust accordingly, or get a consultation for proper fit and use.
When you turn your pump on you need to start in expression mode. Some pumps start in this mode when it turns on, some automatically switch after a couple of minutes, some you need to manually press it. On most (if not all) Medela pumps this is a button with two droplets near it. On a Spectra this is the button with three wavy lines. Expression mode is the mode with the shorter bursts of suction (suck-suck-suck…). This mimics your baby’s shorter quicker sucks to trigger your letdown. Once your milk starts flowing stronger, meaning your letdown has started, press the expression button again to switch back to the longer, stronger pulls (suuuuck-suuuuck-suuuuck). When the milk flow slows or stops, press the button again to go back to the expression mode. Continue to toggle back and forth in this way until you reach the desired amount of milk. If your baby were nursing, this is the pattern they would follow. They also would be using their fists and hands to squeeze and knead your breasts. Your pump cannot do this, so you will need to manually massage and squeeze your breasts as you pump. This will help move the milk from the little milk making pockets called alveoli into the ducts.
Stress inhibits letdown. I know the circumstances of your situation could make it really tough to relax, but find some things that work for you. For me, playing sudoku on my phone helped me zone out and I’d get more milk. I’d also look at pictures and videos of my baby. This helped release my lovey feel good hormone oxytocin which triggers the letdown. You don’t love your pump like you love your baby so it can take longer for a letdown to come when pumping. Smelling a blanket your baby has been wrapped in, or looking at pictures of videos of them could help. You could also try covering the collection bottles with socks so you can’t stare at them and stress how much is in there.
If you have to start pumping from birth, pump often and enough to tell your body the milk is needed.
Let’s say you have had your baby and for whatever reason are unable to nurse at the breast. Maybe baby is in the NICU, maybe you are trying to latch the baby but baby is refusing or it is just too painful. It is important to try to pump as soon after birth as you can. Your nurse may bring a pump in an hour or two after the birth and tell you that they need to get you set up to pump if feeding breastmilk is your wish. The reason is that when your breasts are stimulated within the first hour or two after birth your supply on day 7 is about double what it would be if there is a delay with the first feeding/pumping. This does not mean it’s impossible, you could still achieve a full supply if there is a longer delay, but the nurses just want to be sure that all efforts have been made to set you up for best success. Until you are able to feed your baby and/or your milk is in and supply established you want to pump every 2 hours for about 20 minutes. Colostrum is thick, and sticky, and tough to pump. There are colostrum harvesting kits that can help with this (again you really should be under the care of an IBCLC for this process). You should also be using your hands! Hands on pumping and manually expressing is a good way to get the colostrum. The pumping will mimic your baby nursing and stimulate your body to bring in a milk supply. Your baby would nurse about every 2 hours or more so that message is still being sent via pump in lieu of baby at the breast. Once your milk comes in you want to continue pumping to match what your baby is taking in. Talk to your baby’s care team to see how much milk your baby is needing. A good rule of thumb is to collect about an ounce per hour (so if pumping every 2 hours, 2ish ounces total. If pumping every 3 hours, 3ish ounces total). Some people respond VERY well to the pump and could get 8 ounces in 15 minutes of pumping, this is way too much! Some people don’t respond as well and it could take 20 minutes to get 3 ounces. Once your milk comes in, you can start pumping for amounts and not time. So if you are pumping every 2-3 hours, aim for 2-3 ounces combined. If you have multiples this goal would be multiplied to match the need.
You don’t have to wash your pump parts every single time you pump.
Unless instructed otherwise by a doctor due to a medically fragile child, you do not need to wash your pump parts after each individual nursing session. You can rinse them, put them in a ziplock, and keep them in the fridge. Wash parts with warm soapy water once per day.
Store your milk flat in the freezer for easier storage.
If you are freezing your milk in collection bags, freeze them lying flat with as much air squeezed out as you can. Once frozen you can stand them upright or organize them however works while taking up less space.
Make sure baby is being fed the appropriate amount so you can keep up!
If you are away from baby for work and baby is with a caregiver educate them on appropriate amounts and method of bottle feeding. I can’t tell you how often I get a call that a caregiver is asking for more milk-especially around the four month mark when sleep patterns begin to change- and the parent cannot pump enough to keep up. When I ask about how much milk is being fed and how often the baby is getting a bottle I find that the parent’s supply is fine, but the bottles are way too big! Remember, babies nurse for comfort as well and if a bottle is in their mouth they’ll usually just guzzle it down. It’s easy to mistake sleepy cues for hunger cues, so it winds up that baby is being fed more often and higher amounts than necessary. On average in a given day a breastfed baby will take anywhere between 19-30 ounces of milk. This breaks down to about 0.8-1.25 ounces per hour. The higher end of this range is for babies who are sleeping through the night. Let’s say you and your baby are separated for 10 hours during a work day. You feed at drop off and at pickup. Ten ounces of milk in either five 2 ounce bottles or a mixture of 2-3 ounce bottles is plenty. Your caregiver should be using the Paced Bottle Feeding Method to more closely mimic the flow of the breast. In turn, you’ll want to pump about 10 ounces of milk while you’re away to match baby’s intake.
It is YOUR RIGHT to pump at work. Sometimes though, it can be tough to fit it in.
Make sure that the expectations and your rights as a pumping parent are clear with your employer. They should have set up a space for you that is not a bathroom, is private, has a lock on the door, and is comfortable for you to pump in. If you have a private office you should be allowed a small mini fridge, but your milk is fine in a cooler with ice packs for up to 24 hours. Try to keep this process as smooth and quick as you can. Find nursing/pumping bras so you don’t have to change into a pumping bra. Keep a set of pump parts at work so you won’t have to remember to pack them or risk forgetting them. Bring your collection bottles, but also a large mason jar to consolidate your pumped milk and pack less bottles. Then from that jar you can portion out the next days bottles when you get home.
If you are finding it difficult to set aside the time to pump every 2-3 hours while separated bring a manual pump. Even just five minutes on each side with a manual is better than nothing. Some even manage to pump while they commute if you feel you can do so safely.
I have linked PA State laws for a breastfeeding/chestfeeding and pumping parent here. Head there to learn your rights and send them to your employer if you need to.
How long is this milk good for?
The storage and handling guidelines here are a good rule of thumb to follow. If you notice a metallic or soapy taste to your milk after a few days in the fridge or after being thawed you may have high lipase. This is not harmful and some babies will drink it fine. Some babies will refuse it due to the different taste. Lipase is an enzyme we produce that helps break down fat. If you produce higher amounts of lipase it can change the taste of your milk after it has been in the fridge or freezer. There is a fix for this. You can scald your milk after pumping to prevent the turn in taste from happening. If you are starting a freezer stash, test this out before you have a lot of milk frozen and find out your baby won’t drink it. I had an oversupply early on nursing my son and had 300 ounces in my freezer. Then I found out I produce high lipase and he wouldn’t drink it. I thought I’d have to dump it and it made me so upset, but luckily I asked a milk bank and they were able to take it and donate it. PHEW! Don’t be like me- test your milk before you have hundreds of ounces your baby won’t touch!
As with all things parenting, when starting to pump there are learning curves, phases, questions, and concerns. I hope you’ve learned some tips to get you off to a good start. Remember to have your IBCLC close by for help navigating anything that may come up!
What questions do you have about pumping? What advice would you share with a new parent?