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Breastfeeding Housecalls’
Pumping Class
Laura Gruber, IBCLC, RLC
Is pumping right for my baby and me?
Well, maybe...
Lets first talk about your breastfeeding big-picture.
Ask yourself these questions:
- Do I want to exclusively breastfed feed?
- Has my lactation consultant asked me to pump as a part of a feeding plan?
- Is my baby with me during all of their feeds?
- Am I returning to work/school and need to pump?
- Do you want to pump full-time or part-time?
Breast-Pumping Best Practices
Once you've asked yourself why pumping will be important to you, it's a good idea for you to become familiar with the basics of early milk supply programming in order to be able to understand some of the basics of preserving milk supply that matches your baby's needs while pumping.
The Basics
It takes about 40 days (6 weeks) for your breasts to be 'programmed' to their milk production potential ( this means how much your breasts are capable of making with regular and frequent stimulation and milk removal by your baby or a quality pump-milk supply production potential is different for every mother). Remember that anything that does or doesn't happen during that first season (the first six-ish weeks) after delivering your baby will help optimize future seasons and stages of your breastfeeding relationship.
Ideally, a mother's breast should be stimulated (hopefully by her baby or a high quality pump) within the first six hours after the placenta has been "born" (though optimally, within the first hour after birth). This helps optimize the hormonal "hand-off" from pregnancy to breastfeeding. In the case of milk supply, what you do early in your baby's life, will help it match your baby's needs in later breastfeeding seasons.
But what if my baby cannot come to the breast right away after birth?
Some mothers and babies are separated for medical reasons within the hours or days of life. If this happens to you or your baby, there are ways to stimulate your supply similar to how your baby would stimulate it.
Hospital-Grade Pump
(all pump types will be discussed below)
If you deliver your baby in a hospital, many hospitals can offer you a hospital-grade pump, and any mother whose baby isn't latching well or is separated should ask their nurses about the possibility of using a hospital grade pump during her hospital stay. Moms who use a hospital-grade pump during the first few days after birth should expect to get very little during pumping (this is normal), and should pump as frequently as their babies feed. If you and your baby are separated for medical reasons, the hospital staff will provide you with blunt syringes in which to collect and store the small but important amounts of early milk (colostrum) pumped.
This sweet image shows a dad finger-feeding expressed colostrum (early milk) to his baby via a blunt syringe.
Hand Expression of Breastmilk
Did you know that you can express your milk from your breasts without having a pump? This is called hand-expression, and in the early days of a baby's life hand-expressing can yield more early-milk than even a breast pump.
Hand expression can be done by a mother (or if she is comfortable, it can be done by her partner, a support person or healthcare staff) as soon as her baby is delivered in case her baby can't or won't breastfeed immediately after birth. Just like pumped milk, hand-expressed milk can also be collected and stored in a syringe to be fed to baby.
How do I hand-express?
As with pumping, hand expressing should be done as often as the baby would be feeding (usually about every 1-3 hours as a newborn). You baby's healthcare providers and/or your lactation consultant can best advise you about when and how frequently to hand express or pump since they know your baby's medical condition and feeding needs best.
As mentioned earlier, many moms find that they are able to express much more milk with their hands than they can with the most expensive pump on the market. Why? Because pumps only pull while your hand can pull AND compress, similar to your baby's mouth!
Practice does make perfect so take a minute to watch this very helpful video and practice!
Hand-Expression How-To Video
LAURA'S NOTE: One honest fact about hand-expression is that it can be very consuming and exhausting, especially for tired and swollen postpartum hands. Because of this, hand-expression is a great supplement to pumping, but moms who have electric pumps available to them should ask to have one to incorporate in to their "milk harvesting" routine in case hand-expression becomes difficult.
How to choose a Breast-Pump
for my situation
Well...that also depends.
Start out by asking yourself these questions:
Now, let's break it down:
What is the difference between pumps, and why does it matter which one I use?
When it comes to breast-pumps, not all are created equal...and that's ok, because not every breastfeeding situation needs the exact same breast-pump.
Let’s learn about these-and read below for notes and tips:
Hospital-Grade Breast-Pumps vs. Retail Breast-Pumps vs. Hand-Pumps
The differences between a hospital grade double-electric breast pump and the ones you can buy at the stores (retail pumps) are plentiful. Most hospital grade double-electric breast pumps range in price from $900-$1900 (which is why these are usually rented for much less from lactation centers, hospitals or borrowed from WIC), have motors which can hygenically handle multiple users over the lifetime of the pump, and have different suction strengths and patterns than their "over the counter" retail, single-user breast pumps who range between $100-$600. Both can be good choices, but have a very different impact on milk supply if they are used during the wrong times.
A hospital grade double-electric pump is used for the purpose of establishing milk production potential, and a retail double electric single-user breast pump is meant for preserving an already established milk supply, meaning your milk supply already matches your baby's needs. Using a single-user double electric breastpump, or a hand pump (see below), during the first six weeks of breastfeeding could compromise milk production potential in some women (not all, but in many). For brand new moms who are still unfamiliar with their milk production potential, it is strongly recommended to use a double-electric hospital grade pump during the first six weeks when at-the-breast feeding isn't yet fully established (where available).
SERIOUSLY IMPORTANT CONSIDERATIONS ABOUT CHOOSING YOUR PUMP:
In the world of breast-pumping, pricing no longer reflects purpose, and quality. That's NOT to say that you need to run out and by the most or least expensive pump, but don’t let the price influence your decision since some of the most advanced and expensive pumps aren’t a match with all situations.
One of the best place to get recommendations for a retail pump is from other mothers on online breastfeeding forums. Lactation consultants can’t ethically steer you toward one pump but can, after working with you and learning your situation, talk about pump features that would be helpful (or unhelpful) to you.
Also, privately insured parents: don't accept the first pump your health insurance offers you. Most insurers will send you a list of pump brands to choose from...once you have these, do your homework regarding these brands by reading consumer reviews and asking on online breastfeeding forums.
Uninsured families: most uninsured or underinsured families can receive significant discounts if you purchase your pumps directly from Durable Medical Equipment companies.
Hand (or Manual) Breast-Pumps
Not to be confused with hand-expression
These are breast-pumps that are not electric and are usually for pumping one breast at a time. It is rare (they do exist) to meet a mother who responds better to a hand-pump than to well-practiced hand expression or an electric breast-pump. Because of this, most breastfeeding professionals encourage mothers to use hand/manual pumps only in cases where a baby latches well, mom's milk supply is meeting 100% of his/her growth needs, and there is only is a part-time need for expressed milk.
Silicone single-suction milk collection devices:
While these can be super helpful to collect milk, these are not breastpumps and should not be depended on to bring in or sustain a full milk supply, even if they seem to work wonders during copious milk-production seasons. Since these work on a combination of a single suction, and mom’s own milk ejection, these can mostly collect foremilk.
A word to the wise about wireless/wearable pumps:
These pumps don’t allow you to see nipple placement in the pump for proper placement which can lead to nipple damage and less milk ejection since nipples being straight in a flange is important for optimal removal of milk. Limited removal of milk and improper flange fit can cause plugged ducts, mastitis low milk supply and babies who don’t gain the weight they need to.
Wearing a pump can also limit milk ejection which is driven by hormonal programming in your brain. When your brain is busy multitasking, it may not send the same signals of milk production. We realize that not everyone can do this, but setting boundaries with employers and household members about needing dedicated time for pumping (instead of pumping while multitasking) will ultimately pay off in your body’s productivity for your baby.
Also-never fall asleep with wearable pumps. They can come unsealed and you can lose your precious milk.
Does pumping hurt?
Honestly, yes, it can...if you're doing it wrong but if you're doing it correctly, pumping shouldn't hurt.
Let's look at what could be improved if your pumping hurts...
Reasons why pumping might hurt (all of which have a solution):
The Most Common Offender of Pumping Pain: Breast-Pump Flange Fit
When possible, have an International Board Certified Lactation Consultant (IBCLC) assess a pumping session to ensure that you have a good pump-flange fit (the part of the pump that touches your breast and looks like a funnel). The way a pump flange fits can have a positive or negative impact on how much milk a mother is able to express per session (which can impact milk production potential), and on the health and integrity of your nipples.
Second Most Common Offender: Breast-Pump Suction Strength
Just as the pump's suction is able to bring milk forward and out of your breasts, so can this suction pull the water and blood in your breast skin to the front on your breast which causes edema (swelling and fluid retention). Edema is why nipples appear swollen after pump sessions, and this swelling can be painful.
And with regard to how much you're able to express with swollen nipples and areolas, here's some insight: Just as stepping on a garden hose impacts how much water comes out, so can the amount of edema surrounding your nipple affect how much milk is able to come out of your breasts. When it comes to pumping, increased suction strength does not equal increased milk production.
Two tips to help reduce pumping-specific edema in your nipples and areolas are:
As mentioned above, pumping can hurt for other reasons, such as a breast injury or infection. Remember, pain with breastfeeding is meant to signal that something can be improved.
If pumping hurts even after troubleshooting it yourself, contact an IBCLC who will help you identify and troubleshoot the underlying cause of your pumping pain.
for my situation
Well...that also depends.
Start out by asking yourself these questions:
- How long have I been breastfeeding my current baby?
- Do I have "experienced" breasts (have they met the needs of previous babies)?
- Are my breasts responding well to my current pump (yes, not all breasts like all pumps-and some breasts only like babies).
Now, let's break it down:
What is the difference between pumps, and why does it matter which one I use?
When it comes to breast-pumps, not all are created equal...and that's ok, because not every breastfeeding situation needs the exact same breast-pump.
Let’s learn about these-and read below for notes and tips:
Hospital-Grade Breast-Pumps vs. Retail Breast-Pumps vs. Hand-Pumps
The differences between a hospital grade double-electric breast pump and the ones you can buy at the stores (retail pumps) are plentiful. Most hospital grade double-electric breast pumps range in price from $900-$1900 (which is why these are usually rented for much less from lactation centers, hospitals or borrowed from WIC), have motors which can hygenically handle multiple users over the lifetime of the pump, and have different suction strengths and patterns than their "over the counter" retail, single-user breast pumps who range between $100-$600. Both can be good choices, but have a very different impact on milk supply if they are used during the wrong times.
A hospital grade double-electric pump is used for the purpose of establishing milk production potential, and a retail double electric single-user breast pump is meant for preserving an already established milk supply, meaning your milk supply already matches your baby's needs. Using a single-user double electric breastpump, or a hand pump (see below), during the first six weeks of breastfeeding could compromise milk production potential in some women (not all, but in many). For brand new moms who are still unfamiliar with their milk production potential, it is strongly recommended to use a double-electric hospital grade pump during the first six weeks when at-the-breast feeding isn't yet fully established (where available).
SERIOUSLY IMPORTANT CONSIDERATIONS ABOUT CHOOSING YOUR PUMP:
In the world of breast-pumping, pricing no longer reflects purpose, and quality. That's NOT to say that you need to run out and by the most or least expensive pump, but don’t let the price influence your decision since some of the most advanced and expensive pumps aren’t a match with all situations.
One of the best place to get recommendations for a retail pump is from other mothers on online breastfeeding forums. Lactation consultants can’t ethically steer you toward one pump but can, after working with you and learning your situation, talk about pump features that would be helpful (or unhelpful) to you.
Also, privately insured parents: don't accept the first pump your health insurance offers you. Most insurers will send you a list of pump brands to choose from...once you have these, do your homework regarding these brands by reading consumer reviews and asking on online breastfeeding forums.
Uninsured families: most uninsured or underinsured families can receive significant discounts if you purchase your pumps directly from Durable Medical Equipment companies.
Hand (or Manual) Breast-Pumps
Not to be confused with hand-expression
These are breast-pumps that are not electric and are usually for pumping one breast at a time. It is rare (they do exist) to meet a mother who responds better to a hand-pump than to well-practiced hand expression or an electric breast-pump. Because of this, most breastfeeding professionals encourage mothers to use hand/manual pumps only in cases where a baby latches well, mom's milk supply is meeting 100% of his/her growth needs, and there is only is a part-time need for expressed milk.
Silicone single-suction milk collection devices:
While these can be super helpful to collect milk, these are not breastpumps and should not be depended on to bring in or sustain a full milk supply, even if they seem to work wonders during copious milk-production seasons. Since these work on a combination of a single suction, and mom’s own milk ejection, these can mostly collect foremilk.
A word to the wise about wireless/wearable pumps:
These pumps don’t allow you to see nipple placement in the pump for proper placement which can lead to nipple damage and less milk ejection since nipples being straight in a flange is important for optimal removal of milk. Limited removal of milk and improper flange fit can cause plugged ducts, mastitis low milk supply and babies who don’t gain the weight they need to.
Wearing a pump can also limit milk ejection which is driven by hormonal programming in your brain. When your brain is busy multitasking, it may not send the same signals of milk production. We realize that not everyone can do this, but setting boundaries with employers and household members about needing dedicated time for pumping (instead of pumping while multitasking) will ultimately pay off in your body’s productivity for your baby.
Also-never fall asleep with wearable pumps. They can come unsealed and you can lose your precious milk.
Does pumping hurt?
Honestly, yes, it can...if you're doing it wrong but if you're doing it correctly, pumping shouldn't hurt.
Let's look at what could be improved if your pumping hurts...
Reasons why pumping might hurt (all of which have a solution):
- A wrong pump-flange fit (the funnel-looking thing that you pump in to)
- A breast or nipple infection (see mastitis or thrush)
- A nipple injury (possibly from a poor latch)
The Most Common Offender of Pumping Pain: Breast-Pump Flange Fit
When possible, have an International Board Certified Lactation Consultant (IBCLC) assess a pumping session to ensure that you have a good pump-flange fit (the part of the pump that touches your breast and looks like a funnel). The way a pump flange fits can have a positive or negative impact on how much milk a mother is able to express per session (which can impact milk production potential), and on the health and integrity of your nipples.
Second Most Common Offender: Breast-Pump Suction Strength
Just as the pump's suction is able to bring milk forward and out of your breasts, so can this suction pull the water and blood in your breast skin to the front on your breast which causes edema (swelling and fluid retention). Edema is why nipples appear swollen after pump sessions, and this swelling can be painful.
And with regard to how much you're able to express with swollen nipples and areolas, here's some insight: Just as stepping on a garden hose impacts how much water comes out, so can the amount of edema surrounding your nipple affect how much milk is able to come out of your breasts. When it comes to pumping, increased suction strength does not equal increased milk production.
Two tips to help reduce pumping-specific edema in your nipples and areolas are:
- Most importantly: Use the right flange fit
- During pump sessions, stop and gently "shake out/wiggle/massage” the breasts to recirculate fluids away from the nipple every 5-10 minutes
As mentioned above, pumping can hurt for other reasons, such as a breast injury or infection. Remember, pain with breastfeeding is meant to signal that something can be improved.
If pumping hurts even after troubleshooting it yourself, contact an IBCLC who will help you identify and troubleshoot the underlying cause of your pumping pain.
NOW WHAT?
Now that you are an expert pumper ;), here are some important resources to help your little one bottle-feed, and help you learn milk storage hacks:
Now that you are an expert pumper ;), here are some important resources to help your little one bottle-feed, and help you learn milk storage hacks:
Still have questions? Consider scheduling a TeleHealth Consult with us —or if you live in or near San Antonio, Texas, schedule a housecall!
