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PUMPING BREAST MILK – ALL YOU NEED TO KNOW
When I was a fresh-faced new nurse the hospital where I worked had exactly one pump.
That was for 150 moms who gave birth there each month.
It was not in use most of the time.
Now, some hospitals have a breast pump in every room.
A study on Infant Feeding Practices from 2006-2007 revealed that as many as 85% of women use a breast pump at some point during their breastfeeding journey (source). That said, it is definitely possible to breastfeed a baby without pumping. I can also say with certainty that some women would not have breastfed if they didn’t have this option. However, pumping has become the cultural norm in our society.
Top 3 Motivations for Pumping Breast Milk
1. Flexibility so that mom can leave her baby.
2. Someone else can feed the baby.
- Lots of partners enjoy the fun of feeding. I want to take this opportunity to say that there are other ways to bond with a baby besides feeding. The co-parent is the first person who teaches a baby that love and food are not always connected. (I didn’t come up with that, but I heard it so long ago that I can’t remember where I did hear it.)
- I encourage co-parents to consider infant massage as a special way to connect with their baby. It has many benefits and can be their special thing that they do with the baby
3. Keep up the milk supply when a mom is unable to breastfeed directly.
Whether you are planning to breastfeed, or already are a breastfeeding mom, I can almost guarantee you have thought about pumping.
- When should I pump?
- What kind of pump should I get?
- How much milk should I expect to get when I pump?
- When is the best time to pump?
- Can I borrow someone else’s pump?
Usually the first question a mom asks is “What kind of breast pump should I get?” The more important question is, “Why will I be pumping?” The answer to this question will help determine what kind of pump you should get.
Why Should I Pump?
1. If your baby is born and won’t or can’t breastfeed.
- Babies who go skin-to-skin right after birth will usually start breastfeeding in the first hour.
- For a whole variety of reasons, some babies won’t.
- If your baby hasn’t breastfed by 12-24 hours after birth you should start pumping. This will help your milk come in.
- If your baby is too premature or too sick to breastfeed you should start pumping by 3-6 hours, as recommended by Baby-Friendly USA.
- Pump every 2-3 hours until your baby is breastfeeding well.
2. I recommend “insurance pumping” when a mom has a risk factor for a low supply:
- History of low supply with a previous baby
- Baby who was under 6# 8 oz
- Baby is born 3 or more weeks early
- Large blood loss
- Significant tongue-tie that is not going to be revised right away
- History of any kind of breast surgery
- PCOS (Polycystic Ovary Syndrome)
Insurance pumping means your baby is eating well but you need some extra stimulation to help ensure that you have a good milk supply long term.
- The goal is not to collect a lot of milk, it is just to provide extra stimulation.
- Pump 4-6x/24-hrs.
- Pump within 20 minutes after the baby feeds.
- Don’t worry about insurance pumping during those times when your baby is cluster-feeding.
- “Insurance pumping” is temporary. How long you need to do it is determined by the reason for doing it.
- Talk to a Lactation Consultant for guidance about when you can stop.
- There is the possibility that this will cause an oversupply issue. That is easier to deal with than an undersupply issue.
3. If you need or choose to supplement your baby with formula or donor milk in the first 4-6 weeks of breastfeeding
- You are establishing your milk supply in the first 4-6 weeks. Missing a feeding during this time can have a negative effect on your milk supply.
- After 4-6 weeks if you miss an occasional feeding it may be uncomfortable, but shouldn’t affect your milk supply.
- That plan you had of your partner giving a bottle in the middle of the night so you can sleep through a feeding? That’s not going to work, especially in the early weeks. This is not to say you can never miss a feeding, but it’s just not a good idea in the early weeks.
- Babies fed formula will go longer between feeds.
- If you supplement with formula and don’t pump you can slide down that slippery slope. This is how moms end up formula feeding because they don’t have an inadequate supply. They just didn’t get enough stimulation.
4. Pumping can help you make more milk if you have an insufficient milk supply. 5. Some moms have enough milk, but the baby can’t get enough out for proper growth.
- Pumping will allow them to use their milk to supplement and it will keep up their milk supply.
6. If your baby can’t latch on to your engorged breasts. Pumping can sometimes help soften them.
- This will only work if it is milk making your breast firm.
- Pumping is not going to help if your breasts are firm because they are swollen. This is often what happens when your milk first comes in.
- Reverse Pressure Softening will be more effective in softening swollen breasts.
- When your milk first comes in you may make more than your baby wants to eat. If your breasts don’t soften with feeding this can destroy your milk-producing cells. Pumping can remove enough milk to soften your breasts.
7. If you want someone to give your baby a bottle of your breast milk on a regular basis, you will need to pump at those times. 8. If you want to build a stash of milk in your freezer.
- It’s important to have a freezer stash if you are going back to work or school.
- It’s also good to have a stash for emergencies
9. If you are going to be separated from your baby regularly.
- Pumping is also important during regular separations to keep up your milk supply
- It provides the milk for your baby to eat during the separation.
10. Some women may need to pump in the middle of the night when their baby starts sleeping long stretches.
- Most women’s supply will adjust to the longer stretches.
- However, if your supply decreases then you should pump at least once during the long stretch.
11. If you have to take a medication that is incompatible with breastfeeding. This is called “pump and dump.”
- Many moms are told to pump and dump when it is not actually necessary. I always recommend getting the second opinion from a knowlegeable source.
- Don’t discard any milk until you’ve talked to an LC or The Infant Risk Center.
What Kind of Breast Pump Should I Choose?
It’s best if you start thinking about this question before your baby arrives. Whenever you ask it, the short answer is, get whichever kind of pump meets your needs.All of these moms have different needs.
- A mom who is exclusively pumping for a preemie
- A mom who has an established milk supply and wants to pump an occasional relief bottle.
- A mom who has a full-time job, and is pumping at work
Pumping needs can be different from what you expected them to be. Pumping needs can also change over time.
When choosing a pump the primary questions you should ask are:
- Why am I pumping?
- How often will I be pumping?
- How much time will I have to pump
- What is my budget for a pump?
- Will my insurance provide a pump for me?
- This may limit your choices
- They may not give you a choice
- What is my milk supply like?
- You have a premature baby
- Your baby is too ill to breastfeed
- Your baby is not breastfeeding well before your milk has come in
- You are not breastfeeding at least 8x/day
- Your baby is not breastfeeding effectively due to a weak or dysfunctional suck
- This can result in your baby not getting enough milk out to grow properly
- You might not get enough stimulation to create and maintain a good milk supply
- Your baby is not directly breastfeeding for any reason
- You are planning to exclusively pump
The first few weeks of breastfeeding are when your supply is being established for the long term. It is important that your breasts get a clear message to make lots of milk.
Double electric personal pumps are intended for the mother with the established milk supply (source).
A manual pump is an inexpensive option for the mom with a good milk supply who only needs to pump an occasional relief bottle Hand expression is free. It is great for expressing and collecting colostrum before the milk comes. It is also a nice option when expressing small amounts of milk.
Breast Pump Recommendations
When I had my babies you could rent an electric breast pump, you could use a manual breast pump, and they just came out with a single battery operated pump. I was thrilled to have that last option because the manual pumps were awkward to use and rentals were expensive.
Today there are a dizzying number of choices.
Ever since breast pumps are provided by insurance companies (more on that below) there has been a flood of new breast pumps on the market. They are not all created equal.
The Medela Pump in Style has been around for a very long time. It is tried and true.
The Spectra has gotten great reviews by the moms I work with as well as on Amazon.
Manual pumps that perform really well are the Medela Harmony
And moms love the Haaka. Gotta love a low tech, easy to clean option.
A lot of moms will keep a manual pump on hand as well as having an electric pump.
Breast Pumps and Insurance
The Affordable Care Act mandates that insurance companies cover the cost of a breast pump.
It does not specify what kind of breast pump. Typically they have provided double electric personal pumps.
They may give you a choice of pump or they may just have one pump available.
You may be sent the pump directly. You may be sent to a website or told to call a durable medical equipment company. I had one mom tell me she was told to go to Target and get one. The insurance company paid for it so she didn’t have to get reimbursed.
Each insurance company has their own way of doing things so it is best to call them and find out what yours will do.
Medicaid coverage varies from state to state. If you have Medicaid you may be told to contact WIC for a breast pump.
Second Hand and Used Breast pumps
A frequent question I get is whether it is ok to use a breast pump that someone else has used, or if a mom can use the same pump she used with an older baby. The answer is a hard no. There are two reasons for this.
1. Closed vs Open System
Breast pumps are one of two types of systems.
A closed system means that milk cannot get into the motor because there is a barrier preventing this. An open system does not have that barrier.
If milk gets into the motor there is the potential for the growth of mold or bacteria and viruses to be transmitted from one user to another. People have taken these pumps apart and found mold in the motor (gross, right?).
2. There is another reason you shouldn’t use a pump that has been used before.
Breast pumps are like any other piece of electronic equipment. The motor is made to function at 100 % for a certain period of time. Then it will get old and tired. New pumps are being created all the time so it is a good idea to check if you are concerned about whether a pump has an open or closed system.
When Is the Best Time Pump My Breast Milk?
The best time to pump will depend on why you are pumping. You can probably understand now why that was such an important question to answer first.
You should pump right after a feeding for a relief bottle or to build a freezer stash. This way you will be taking the leftovers and won’t cut into your baby’s next feeding. To get the most milk you should pick a time to pump when your milk supply is most abundant. For most moms that will be in the earlier morning hours. The amount you get may be different than what other moms get. Don’t compare yourself to other moms. The first time you offer a bottle you don’t need a lot of milk. You just want to see what your baby thinks of this whole bottle business. If she is not a fan you won’t have to throw a lot of milk away if you only offer 1/2 – 1 ounce.
Building a freezer stash
Every mom should have a breast milk stash for emergencies. I recommend 24 hours worth of feedings. You may need to pump more than once a day if you are trying to get a stash in the freezer for going back to work or school. It will depend on how much you get and how far in advance you start working on it.
How to Pump
Each Pump has different parts, so read the instructions or have a Lactation Consultant show you.
Breast massage and hands-on pumping help you pump more milk.
Troubleshooting for poor or no suction
- Make sure all parts are intact and connected tightly.
- Replace parts. Start with the smallest piece. See if it makes a difference and progressively work your way up to the tubing. For Medela pumps the membranes wear out and can result in poor suction. I recommend replacing them every month or two.
- Have extra pieces of parts that can wear out.
- How old is the pump? Could the motor be wearing out?
- Call the pump company’s customer service number. Most companies are really good about replacing your pump if it is not working properly.
- Consider renting a pump for a week if you are not sure if your pump needs to be replaced.
How Much Milk Should I Get When I Pump?
It can be a little intimidating if you are barely covering the bottom of a bottle.
Things that will affect how much you pump:
- Whether you pump after a feeding or instead of a feeding
- How long it has been since the last feeding or pumping
- How often you pump
- Some moms pump really frequently. They have fooled their body into thinking they have twins.
- How much milk you produce
- Some moms produce just enough
- Some moms produce way more than they need for their baby
- What kind of pump you have
- How old that pump is
All you need is enough. If you don’t get enough, it can help to talk to a Lactation Consultant to see if you can do anything to get more milk.
Breast Pump Hygiene
Proper cleaning of your breast pump is very important. The CDC came out with a new guideline to properly clean pumps in 2017.
Products That Will Make Pumping Easier and More Comfortable
- Hands-Free Pumping Bra. Some moms like Pumpin’ Pals.
- Lanolin to put on the pump flange can make pumping so much more comfortable.
- If you pump more than once a day, having an extra pump kit allows you to wash parts less often.
- A Wet/Dry Bag and Mat for Your pump Parts.
Now You Know
EVERYTHING ABOUT PUMPING BREAST MILK
Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.