WHEN SHOULD I START PUMPING?

When I meet with a brand new mom, one of the most common questions she asks is, when should I start pumping?

While this might seem like a simple question, it can have many different answers. That is because when you should start pumping depends on why you need or want to express breast milk.

The correct answer can range from before you give birth to never. 

Pumping is popular with today’s moms, but it is not essential to breastfeeding.

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I’ll talk about all the different reasons you might need or want to pump. I’ll provide guidelines about the best time to start pumping for each scenario. 

 

PUMPING WHILE PREGNANT

You might have been surprised to see this section. Pumping while pregnant is not common. But there are some times when a woman might be advised to do some pumping before birth.

Pumping Colostrum While Pregnant

Your breasts make colostrum before your baby is born. Colostrum is a special early milk that is the perfect first food for newborns.

It contains infection-fighting antibodies and has the perfect amount of protein, fat, and carbohydrates for a baby transitioning from being fed through the umbilical cord to eating themself.

It is produced in small amounts, which is perfect for the tiny size of an infant’s stomach.

Often referred to as antenatal milk expression, pumping colostrum during pregnancy has been recommended to women with Type I or gestational diabetes.

Infants born to women with diabetes are at higher risk for experiencing low blood sugar.

If a baby needs to be supplemented, they can be fed the colostrum their mother collected during pregnancy instead of using formula.

The colostrum collected can be frozen and then taken to the hospital to be used if needed. 

Expressing colostrum while pregnant can be done by pumping or hand expression.

Pumping To Induce Labor

Another reason for pumping while pregnant is to try to induce labor. 

Breast stimulation will send the message to your pituitary gland to release oxytocin. Oxytocin causes the milk to let down. It also causes uterine contractions.

You should only try pumping to induce labor if your doctor or midwife is guiding you.

 

FOCUS ON LEARNING HOW TO BREASTFEED FIRST

If breastfeeding is going well, I encourage you to spend the first two to three weeks focusing on just breastfeeding.

• Learn your baby’s feeding cues.
• Experiment with different positions
• Get help from a lactation consultant with any breastfeeding problems you may experience
• Rest when your baby is sleeping

If there is no reason to pump those first few weeks, just enjoy your new baby and get breastfeeding established. Once breastfeeding is established, you can think about starting to pump.

I tell a mom that breastfeeding is established when you do it without thinking about the details.

• You can quickly recognize your baby’s feeding cues
• You easily latch your baby without any discomfort
• Your baby is swallowing frequently, having lots of wet and soiled diapers, and is gaining weight at an average rate (above average weight gain is fine also).
• Any engorgement has been resolved.

Once you feel confident with breastfeeding, you can get to know your pump, whether you plan to do regular pumping or just expect to do occasional pumping. 

Let’s go over those situations when you need to pump in those first few weeks or even days.

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PUMPING WHEN YOUR BABY IS BORN PREMATURE

A baby born prematurely may or may not be able to breastfeed. It will depend on how soon before their due date the baby arrives. It can also be a factor if a premature baby has other medical concerns.

Premature babies can have a multitude of breastfeeding obstacles and challenges.

• They may need assistance with breathing from a ventilator or other devices.
• Premies often have a weak suck which can make it difficult to get enough milk out.
  • They may need to be fed through a tube or with a bottle.
  • It is important that there be a robust demand to create an adequate supply long-term.
• Babies born early tire easily when feeding.
• Be too physiologically unstable to move.

Many premies will benefit from skin-to-skin contact with their mother even if they are not ready to breastfeed.

If you are pumping for a baby born prematurely, you should start pumping within six hours of the birth (Source). Starting sooner than six hours is fine and may be advantageous.

You should pump 8-10 times every 24-hours. Each pumping session should last 10-20 minutes. But if you can only pump for five minutes, that is better than skipping a pumping session.

When pumping for a premature baby, it’s best to use a hospital-grade electric breast pump and to do double pumping, which is where you pump both breasts at the same time.

It’s ideal to space pumping sessions apart equally, but it is not essential. You can take one four-hour stretch to get a little extra sleep. 

When timing pumping sessions, you go from the start of one session to the start of the next.

To ensure you are getting all your pumping sessions in, put eight individual snacks in a bowl, and you can eat one each time you pump. It can be nuts, chocolate chips, dried fruit – whatever is motivating. 

In addition to pumping, you should do hand expression. Research has shown this will help your milk supply (Source).

 

BABY WON’T LATCH (OR CAN”T)

Most babies want to eat within an hour of birth. Some, however, are not interested. Others have difficulty. If you have a baby who is not latching, do lots of skin to skin. Some babies need a little bit of time and patience.

If twelve hours have passed and your baby still won’t latch, you should start pumping and doing hand expression. Feed them whatever you pump or express with a spoon.

Keep pumping every 2-3 hours until your baby is breastfeeding regularly.

If breastfeeding still hasn’t started by 18-24 hours, you should meet with a lactation consultant.

 

BABY BREASTFEEDS INFREQUENTLY

It is essential for a good milk supply to have breast stimulation at least eight times each 24-hours. You should do some pumping if your baby has started to breastfeed but is breastfeeding less than eight times every 24-hours. 

Moms often worry that nothing will be in their breasts if they pump, and then their baby wakes up. Rest assured, there is always something in your breasts because you are always making milk.

Give your baby the opportunity to breastfeed before you pump. Place your baby skin to skin if it has been two and a half hours since the beginning of the last feeding or pumping session. If he doesn’t wake up and feed and you have tried all the tricks for feeding a sleepy baby, go ahead and pump. If your baby wakes up after you pump, go ahead and offer your breast. After baby nurses, you can feed anything you expressed

 

BABY IS NOT BREASTFEEDING WELL

There are babies who want to breastfeed but are just not doing a good job when they go to breast.

These are some possible reasons a baby doesn’t breastfeed effectively:

• Low muscle tone
• Down’s syndrome
• Cleft lip or palate
• Tongue-tie
• Baby is sick

In these and other situations where a baby is not breastfeeding well a lactation consultant may suggest you pump in addition to breastfeeding. 

Most mothers are surprised at how strong a baby’s suck is. If you feel like your baby’s suck is weak or if it feels more like biting than sucking, you should consider pumping in addition to nursing.

 

PUMP IF YOU ARE SUPPLEMENTING

In the first four to six weeks, your body is figuring out how much milk it should make. If you have to supplement breastfeeding with formula, human donor milk or even milk you have pumped previously, you should pump.

There are different reasons why a mom would need to supplement breastfeeding.

• She has a low milk supply, and her baby needs more than he is getting from the breast.
• She has enough milk but her baby can’t get it out of her breast.
• She has a temporary dip in her supply but has milk she previously pumped.
• She may have chosen to skip a feeding.
• Her family is pressuring her to offer formula

Whatever the reason, you should pump any time you give formula to ensure that you are getting adequate breast stimulation.

Ideally, you would pump when the supplement is being given.

 

BABY ONLY BREASTFEEDS ON ONE SIDE

Babies don’t always breastfeed from both breasts. Moms want to know if they need to pump if their baby only breastfeeds on one side at a feeding.

Whether or not you need to pump depends.

• How old your baby is when they only nurse on one side?
• Is your other breast uncomfortably full?

I like to say that the second side is like dessert. It is always polite to offer it, but it is okay if your baby doesn’t want it.

Sometimes a baby will want a short (15 or 20 minutes) break between the first side and second side. That is okay too.

Especially when your milk first comes in, your production may exceed what your baby wants.

Always offer the second side but don’t worry if your baby doesn’t want it. Just offer that side at the beginning of the next feeding.

If your breast feels uncomfortably full you can go ahead and pump enough to feel more comfortable.

Depending on how much milk you are producing you may make enough for one side to fill your baby up. If you consistently pump the other side you could end up with an oversupply problem. In most situations you want your baby to tell your breasts how much milk they should make.

 

PUMPING TO BUILD A BREAST MILK FREEZER STASH

I think it is a good idea for every mom to have a milk stash in her freezer. 

Once breastfeeding is well established, you can start pumping after feeding to build your freezer stash. This might be as early as two weeks or closer to six weeks or later. Every mom and baby is different, so go at your own pace. 

 

WHEN TO START PUMPING BEFORE GOING BACK TO WORK

You should start pumping four to six weeks before you go back to work. This should give you ample time to build a freezer stash of milk.  

You want to pump after feeding so you are not taking food away from your baby. Most moms have their most abundant milk supply in the morning hours.

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INSURANCE PUMPING

Insurance pumping doesn’t have anything to do with your health insurance.

There are times when a baby may be breastfeeding well, but there is a risk of insufficient stimulation or low milk supply. In these situations, a mom should pump after breastfeeding.

I call this insurance pumping because you are pumping to ensure you will have a good milk supply long term.

Small Babies And Pumping

When a baby is less than 6 1/2 pounds at birth, they may not stimulate a good milk supply. This can be because their suck is not strong.

Another reason a small baby may not create an adequate milk supply is milk production works on supply and demand. If a baby is not taking much, they are telling your breasts not to make as much.

Pumping When Using A Nipple Shield

If you use a nipple shield in the early days and weeks of breastfeeding, it is a good idea to pump after feedings to ensure adequate stimulation and emptying.

History Of Low Milk Supply

If you had a low milk supply with another baby insurance pumping may help you avoid the same problem. It won’t guarantee a full milk supply, but it can help.

History Of Breast Surgery

Breast surgery of any kind has the potential to affect your milk supply. Pumping can minimize the effects of breast surgery on your milk production.

It’s best to pump within 15-20 minutes of the end of the breastfeeding session. This is because you don’t want to take food away from the baby’s next feeding.

You can use the extra milk you are pumping to start your freezer stash. 

 

DO I NEED TO PUMP IF I MISS A FEEDING?

For at least the first six to eight weeks, your body is establishing your milk supply. If you don’t get enough stimulation during this time, you might not make enough milk, so you should pump if you miss a breastfeeding. 

For most moms, their breasts will start to feel full and uncomfortable if they miss a feeding, and they will want to pump. 

The other thing that can lead to a decreased supply is full breasts tell your body to make less milk if the milk is not removed.

As you get further along in your breastfeeding journey, your body becomes more flexible about responding to increases and decreases in demand. 

Once your supply is well established, you can probably skip pumping if you have to miss a feeding. Your breasts may still get uncomfortably full, though.

When you are working, you ideally will pump at the times when your baby would be breastfeeding. This will help maintain your breast milk supply. 

If you cannot pump that frequently, pump as often as you can. Many women will keep up with the same milk output as long as they pump the same volume.

 

PUMPING TO INCREASE MILK SUPPLY

Pumping, in addition to breastfeeding, is a popular method to increase milk supply. It taps into the supply and demand thing. By pumping, you are telling your body to make more milk.

When To Pump To Increase Milk Supply

The timing of pumping to increase supply is critical. 

You don’t want to take food away from your baby’s next feeding. 

If you’re pumping to try to increase your supply, you want to pump within 15-20 minutes of the end of a feeding. 

Baby’s typically leave some milk in the breast. This is true even when a mom has a low milk supply. Pumping and hand expression can more thoroughly drain the breast, which tells your body it should make more milk.

Waiting longer than 15-20 minutes after your baby breastfeeds can remove milk that your breasts were making in preparation for the next feeding.

 

PUMPING TO RELIEVE ENGORGEMENT

When your milk first comes in, your breasts will probably get engorged. Your breast may get much larger and firmer than usual. Moms often think there must be gallons of milk in there.

That is not always the case. There are actually two types of engorgement.

Primary engorgement happens when your milk first comes in is often a result of swelling of the tissue around the milk-making glands. 

If your baby feeds and your breasts still feel hard, you can pump and see if there is a lot of milk in them. If the swelling is causing them to be hard, you won’t get much, if any, milk when you pump. 

If you try pumping and are not getting any milk or just drops of milk, you should stop pumping. Instead, try applying some ice packs to decrease the swelling.

If you do get a good flow of milk when you pump, you should just pump off enough until you feel more comfortable. If you keep pumping large amounts of milk, you might create an oversupply problem. The exception would be if you are pumping because you are at risk for a low milk supply.

Call a lactation consultant if you are unsure how much you should be pumping because you are engorged. She can get all the specifics and help you create the best plan for you. 

Another reason for pumping during engorgement is it may be difficult for your baby to latch on to your firm breasts. Pumping a little milk off can help soften your breasts and make it easier for your baby to latch. Often a manual pump works well for this. 

The other type of engorgement is when your breasts get very full of milk because you have gone a longer stretch than usual between feedings. Feeding or breast pumping will relieve this type of engorgement.

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PLANNING TO EXCLUSIVELY PUMP

If you are planning to exclusively pump right from the start, you should start pumping within six hours of giving birth. You will want to pump at least eight times each 24-hours.

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PUMPING AND DUMPING

Pumping and dumping is the phrase used to describe discarding your pumped milk.

The most common reason for pumping and dumping is when a mom has to take a medication that is incompatible with breastfeeding.

I encourage you to get reliable information about whether pumping and dumping is actually necessary. Moms are often told they need to pump and dump when they don’t really need to.

 

OVERSUPPLY OF BREAST MILK AND PUMPING 

A mother can cause an oversupply of breast milk by pumping a lot more than her baby needs. This can happen if she is trying to store a lot of milk in a short period of time.

It is also true that some moms just make a lot more milk than their baby needs. They feel uncomfortably full if they don’t pump. If this is happening to you, try to avoid pumping until empty. Pump just enough to feel more comfortable.

 

PUMPING AND DRINKING

Moms who want to enjoy an alcoholic beverage occasionally may think they have to pump and dump, so their baby does not get spiked milk. If you time your drinking carefully, you don’t have to do this. 

If you have one “serving” of an adult beverage, the alcohol transfers into the milk within 30-60 minutes and transfers out within two to three hours (Source). 

What is considered a serving depends on the beverage. The single-serving volume is different for wine, beer, and spirits.

If you have more than one drink, you may need to pump for comfort if you feel full and still buzzed. You would not want to feed your baby that milk. But you don’t have to discard it because it can be used for a variety of things.

 

SHOULD I PUMP IF BABY SLEEPS THROUGH THE NIGHT?

Most moms do not need to pump when their baby starts to sleep through the night.

A baby who is dropping nighttime feedings will be feeding more during the day, either more frequently or taking more volume at each feed. As a result, your supply should not drop.

However, some women have milk supplies that are very sensitive to going longer stretches without stimulation. If you feel like your breast milk production is decreasing, you might want to pump right before you go to sleep if your baby has gone down for the night a few hours before you.

 

FINAL THOUGHTS ON WHEN SHOULD I START PUMPING

You can see now why there isn’t a simple answer to the question of when a mother should start pumping.

Whether you are pumping to relieve breast fullness or to try to increase your supply of breast milk, I hope these guidelines have provided you with a good idea of when you should start pumping.