Ask An LC: What About Pumping?

Welcome to “Ask an LC” by Melissa Yetter RN CLC

Melissa Yetter RN CLC is an experienced OB/L&D/Newborn nurse since the 70’s. She started her specialized lactation career in 1988, became a CLC in 1991, and went on to IBCLC in 1993, renewed in 1998. Due to unforeseen circumstances, she opted out of the required 10 year IBCLC recertification exam in 2003. She has always maintained CLC status.  She recently recertified for CLC (Certified Lactation Counselor) in 2008. She blogs at “Stork Stories… Birth & Breastfeeding” about her experiences as a maternity nurse and lactation professional from the 1970’s to present.

Great Questions:

@rotormommy – I have to go back to work at 6 weeks. When should I start pumping and having my husband feed her so I can still BF when I’m home?

@TheMomCrowd – Q: I would like to pump, but then I am empty when baby wants to eat. If I feed pumped milk what’s the point? I don’t make extra.

photo credit: Amber Slatosky

What About Pumping?

If you plan to supply your own milk when you are away from your baby either for an occasional outing or returning to work/school outside the home, you’ll need to decide how you will express your milk into a container to feed to the baby. Although the use of a breast pump is the most popular, hand expression can also be very effective and quite cheap for those who don’t wish to use a pump. It is also a valuable skill to learn. Your hands are always with you! Most of what I discuss may be about the use of a breast pump as a tool for milk expression; those of you who hand express can still use some of this information for your situation. It should also be mentioned that regular expression to help initiate or improve a low milk supply [Link] is different from these questions asked above. These will be answered with an understanding that there is already an established milk supply.

I have found it’s important for mothers to understand that pumping is a substitute for the real thing and that it takes practice for lots of moms. I always say to expect hardly anything the first time you try then whatever milk you may get is wonderful! One very important point to realize is that whatever you see come out with a pump or hand expression is NOT a reflection of how much a baby gets in a feeding when he is well latched and effectively feeding. What you see come out with the pump is what your body released at that moment in time. Even women with a great supply and healthy growing babies can have trouble learning to pump. The baby is the master …you are merely trying to imitate him! The type of pump used and when you pump in relation to the age of the baby as well as the time of day, frequency etc. can have a big impact on your results.

The general rule is: More Out means More Made. (Morbacher) The more milk drained from the breast- the more milk the breast will make!

What Kind of Pump?

How Long Will You be Away From Your Baby?

Regular intervals…such as work full or part-time.

It is important for this to be as efficient, comfortable and convenient for you as possible to make this work. Your goal may be to keep your supply up while away from your baby or to provide all of your baby’s nutritional needs thru your own milk. The best advice is to either rent a high quality pump or purchase an electric pump with at least 40 to 60 suction/release cycles per minute. Faster frequencies (up over 100) are not necessarily associated with improved results or higher volumes of milk. [Link] Cycles fewer than this though are associated with a gradually decreasing supply. When you think about your goal, and you think about the cost of a quality pump, remember that formula could cost you up to around $200-$250 per month!!!  A quality pump is a good investment!

 Minimal Part-time work or occasional separation.

If you have the budget, any type of pump described above is wonderful! You may also be just fine with a less expensive pump or one with fewer cycles per minute. You could do fine with a good cheaper, manual pump. Many manual or battery operated pumps have an automatic suction release feature which can be convenient. Battery pumps without an AC electric adaptor can go through batteries quickly depending on the pump. Also, the highest suction setting doesn’t always help you get the most milk. Your milk flows most when you have a “let-down”or milk release, not because of constant suction. Without a letdown, a lot of milk can stay in the breast. The pump should have a suction control. Set the pump at the strongest setting that is comfortable for you. It should not hurt!

I have purposefully NOT listed any particular pump so as not to endorse any product.  I would recommend you read the info on each pump you are interested in and do your homework for your specific needs.

When Should You Pump?

If you are getting ready to go back to work or school.

When a mother needs or wishes to return to work by 6 – 8 weeks after the baby is born, as asked above, and wishes to “build up a stock-pile of milk,” it is recommended she begin pumping after breastfeeding is well established around 3 weeks of age. If you are going back to work/school later than that, you could start the process about 2-3 weeks before going back. We usually suggest practicing pumping for the first time in the morning hours about an hour or so after a baby feeds. There seems to be a naturally higher volume of milk during morning hours as opposed to evening. Scientists think this may be due to higher prolactin (the milk-making hormone) levels in the middle of the night. Many times at around 3 weeks, the breasts are still feeling full a lot of the time and there could be some re-accumulation of milk in the breasts from the last feeding so mom can have better results with practice. If you are still worried there won’t be milk available for your baby when he’s ready, you can try practicing pumping on justone breast.  Another good time to try is if your baby seems to have a longer nap than usual. Some moms have liked to pump just a little several times during a day, storing each in fridge and then combining when cooled.

Once you practice in the morning, you may also be able to get your body to respond to the pump at other times during the day. Practice, practice, practice and be patient with yourself. Trust your body. You can learn to do this if it is important to you! Some moms are lucky and need very little practice. For others, it may take awhile.  Once you have returned to work, the best way to maintain your supply would be to pump every time the baby would be feeding.  There are many moms who aren’t able to pump that often at their jobs, and still work out a balance between work and home. Some moms feed the baby much more often when at home and the baby ends up not needing many feedings while you are away. The need for frequent pumping doesn’t last forever. It is more important for young babies under 3 months. As the baby gets older, you can usually space it out and when he begins solids by 6 months or so, some moms can really decrease the amount of pumping needed while away, and focus on a lot of breastfeeding when together. The main key principle is supply and demand or the more milk going out of the breast equals more milk made. Your personal goals and motivation to meet those goals will help determine what you do.

If you are getting ready for an occasional time away from breastfeeding.

Maybe you are going to an event like a wedding or just need someone to feed your milk to your baby for a different reason. Perhaps you or your baby is unable to nurse temporarily due to illness. [Link] The principles of practicing to pump in the morning or an occasional longer nap as described above should still help you. Many moms have found it easy to express from one breast while the baby nurses from the other (if you only need one hand for each. It can be very beneficial to take advantage of the letdown stimulated by the baby. If you have the time and it’s imortant to you then you should beable to make it work. Sometimes an event can occur suddenly like an ill family member and you don’t have time to practice. This can be stressful for you and the last thing you need is uncomfortable full breasts! It is possible to try relaxation techniques, warm compresses, breast massage, smell a blanket or clothing from your baby or just thinking about the baby to help you pump or express. You can even go into a private restroom and express both full breasts into a sink to relieve yourself.

After I Pump What About That Empty Feeling?

Anytime mom feels like her breasts are feeling empty, we first have a quick look at the whole picture to evaluate if this is normal breast changes through the experience and evaluate whether her supply is good and the baby’s weight gain adequate.  There may be moms with great supplies who experience their breasts feeling empty after they begin pumping. They wonder if there will be any milk to now feed the baby. This is a very common concern- you are not alone. It is a misconception or myth that full breasts make more milk. Full breasts actually create pressure in the breast which tells the breast:  “Hey–we aren’t using this milk… its backing up–so stop making it!” When the breasts are drained or emptied more often, the message is: “Hey—they are using this milk up like crazy! Keep making more –increase the product!”There is also usually a lot of milk made on the spot for any given feeding.

When a mother first starts pumping, it may take a few feedings to adjust to more milk taken out of the breast. When a mother has to use a pump on a regular basis, it may take a few days for the breasts to get used to the change. It usually takes a few days for the breasts to respond to the increased need during periods of rapid growth, frequency days or when a mom needs to increase her supply because it is low. [Link]

Even after being reassured this could be normal, some babies are used to a quick flow of accumulated milk at the beginning of a feeding and may act upset if the milk doesn’t seem to come out as quickly right in the beginning of the feeding as they are used to. If you have this situation, it may be best for you to try practicing pumping on just one breast; or for short periods throughout the day and combine your results after cooled. Give your body some time to adjust and it can work.Follow your heart. If you really want to provide your own milk for your baby when you are not together for whatever the reason, you can do it!  I have worked with two different flight attendants who returned to work with babies under the age of 5 months. They were both able to maintain a supply even when away for 4-5 days at a time. Each handled things their own way and each felt very successful!

Whatever your situation or whatever your goals; you CAN still make breastfeeding work! Enjoy your baby!

References:

Various links throughout post

Additional references:

Center for Breastfeeding Education, Healthy Children’s Project: Course Syllabus; Lactation Counselor Certificate Training Program; Ft. Collins, Colorado; October 2008

Cadwell K, Turner-Maffei C.: Pocket Guide for Lactation Management.  Jones and Bartlett Publishers, Inc, Sudbury, MA 2008

Kent JC, Ramsay DT, Doherty D, Larsson M, Hartmann PE.: Response of breasts to different stimulation patterns of an electric breast pump. J Hum Lactation. 2003 Aug;19(3):269.

Mitoulas LR, Lai CT, Gurrin LC, Larsson M, Hartmann PE: Efficacy of breast milk expression using an electric breast pump. J Hum Lactation. 2002 Nov;18(4):344-52

Morbacher N, Kendall-Tackett, K: Breastfeeding Made Simple. New Harbinger Publications, Inc , Oakland, CA 2005

Related posts:

1. Monday Musings: Is It Okay To Advertise Baby Bottles To Pumping Moms?
2. Ask An LC: About Milk Supply

Tags: hand expression, milk supply, prolactin, pumping, supply and demand, working