This amazing mom pumped with hand pump while hiking in Maine for 3 days to keep up her supply. Thank you so much @straightfromthetap_milklady (Instagram) for your adventurous spirit and for sharing this fantastic and beautiful photo!
photo from the CDC Media Center
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Pumping is an incredibly helpful tool for any breastfeeding family
It can provide milk for an exclusive pumping family, for when the lactating parent is away from the baby, if there are latch difficulties, to relieve overly fully breasts, to help boost supply, and for so many more reasons.
It’s wonderful that pumps are available through insurance, but it’s also a mixed blessing that there are many pumps out on the market. The good news is that pumps can be free or affordable. The bad news is not all pumps are made alike! In fact, too many of them are very poorly made. Also most pumps come with flanges that are too large for the vast majority of users (more on this below)
Also, the commonplace availability of pumps has led people to believe that they should pump right after having a baby. This is not necessarily true - if breastfeeding is comfortable and effective and you want to wait on pumping, it’s fine to wait. In fact pumping on top of effective breastfeeding can lead to an oversupply if it’s not carefully planned out. However, for exclusive pumping, or if someone needs to pump because of breastfeeding problems - then it is very important to start pumping or hand expressing right away (and of course make a plan with your IBCLC).
How often you need to pump or hand express depends on your situation. Here are some examples:
For exclusive pumping, if a baby is not nursing (or nursing well), or for any other reason - we look to what we expect of a newborn nursing in the early days - typically feeding 8-12 times per day. So, to bring in a full supply, we usually start by double pumping 8 times per day (short sessions - 10-15 min usually). This signals to your body that the baby is drinking milk frequently. And, then based on how much milk you are making, we may adjust this number of sessions up or down.
If a baby is nursing part-time, or nursing full time but ineffectively (not taking in the full feeding) - then there’s a bit of “lactation math” that needs to be done to figure out the right amount of pumping for your situation - enough to keep you within your lactation goals, but not so much to overwork you. Work with your IBCLC to assess your supply, baby’s latch, and how to utilize pumping for your scenario!
Pump effectively and comfortably!
Flange fitting! To get the most milk (and get it comfortably) this is essential. We used to tell people that there should be space around the nipple, but new research has shown that a flange that matches the diameter of your nipple is usually best. The pump companies have not caught up with this fact and are still providing 24 mm and larger flanges. So, doing a flange fitting with your IBCLC is incredibly valuable. Not only for size, but for pump settings, type of flange, and more. Meanwhile, here are some helpful online resources:
Flange “FITS” guide by Babies in Common
Flange fit video from Katy Linda at The Breastfeeding Den
Hands-on pumping - This is very informative video from Stanford Medical Center on how to use your hands for massage while pumping. Hand Expression is shown as part of this video from Stanford Medical - for more info see my other blog post on hand expression
Lubrication of the nipple/areola junction often helps with flange fit and comfort. Non-lanolin nipple balms are a good option (lanolin is too sticky for this purpose!). Other options include organic olive oil or coconut oil. All are generally regarded as safe for babies but always check ingredients and consider your own family history of allergy.
"Power Pumping by Exclusive Pumping
“Haaka’s” and milk collectors, Hands-free pumping bras, and Milk Storage
Related to pumping, and very popular but not technically pumping are using Soft Silicone Milk Extractors (most common brand is Haaka, but there are many types - “generic” brands, as well as ones that fit in your bra like the Ladybug or the Elvie Curve, etc).
Video from Katy Linda at The Breastfeeding Den
Instagram post showing how to place them for better comfort and milk removal
I always recommend smaller/lighter ones (100 ml or less) - the larger ones, and ones that have extra parts often pull uncomfortably on the breast.
Pumping (or “Haaka”-ing) on one side while nursing on the other
There are many types of passive milk collectors - no vacuum, but they sit in your bra and collect leaking milk.
Having something hold the flanges for you (Hands-free pumping). This could be:
A dedicated pumping bra that you change into for each pumping session.
A nursing/pumping bra that you wear all the time (my preference for sure because you don’t have to change every time!)
A sports bra, or any bra, that has enough flexibility to pull open and hold the outside the flange to you
Creative ways to pump hands-free:
Ponytail Holder trick by Jessica Barton, IBCLC
Homemade pumping bra - Out of elastic bands, or From an old sports bra
Hands-free pumping - combining milk collection cups (like Freemie or Legendairy) with a portable pump like Baby Buddha
All-in-one hands-free pumps like Willow or Elvie are very convenient but it’s crucial to fit them correctly with inserts (here is one example) and sometimes they are not as strong as a stand-alone pump (like a Spectra or Baby Buddha)
Milk Storage, Thawing and Feeding Guidelines
New CDC guidelines (updated Jan 2020)
The articles linked next were written before the CDC updated their guidelines. I am including them here, though, because the overall info is very helpful
Nancy Mohrbacher “Why Milk Storage Guidelines Differ”
The Milk Meg “Keep on Pumpin’, Breastmilk Storage Guidelines”
The main difference between these article and the newer guidelines is that we used to say milk was good in the fridge or room temperature a bit longer. So, use these articles for their great info, but also keep in mind that if you go beyond the CDC guidelines it’s wise to smell/taste the milk to judge if it’s still good. And, if you think the milk is not suitable for drinking, it’s still great for the baby’s skin in a milk bath!