Pumping Frequently Asked Questions
BREASTPUMPS
1. What kind of breast pump should I buy, and when should I purchase it?
Purchasing a breastpump should be according to your need. Many mothers
breastfeed their babies for two years or more and never use a breastpump. It’s
best to wait until after your baby is born to decide which pump you should buy.
If you buy a pump during your pregnancy, it might not be sufficient to meet your
needs after your baby is born. You can buy the pump which best meets your needs
when it becomes apparent you need a pump. However, it can be stressful to
research a breastpump at this time. It is helpful for you to know about the
different types of pumps, and when they are best used, prior to the delivery of
your baby.
If you need to pump in the 1st six weeks you will need an automatic cycling
double electric breastpump. This is a critical period in the development of your
milk supply. Needing a pump at this time means your baby is not nursing well,
your milk supply is not meeting your baby’s needs for growth, your breasts are
engorged and the baby is unable to access your milk, or you or your baby are ill
and possibly hospitalised.
If you need to be separated from your baby for occasional feeds after
breastfeeding has been well-established in the first six weeks, a single manual
or electric breast pump will usually meet your needs. If you will be regularly
leaving your baby for more than one feed a day in the first year, a double
electric breastpump is recommended to ensure maintenance of the milk supply.
2. I’ve read that using electric pumps is unhealthy. Is this true?
A breastpump should have an automatic vacuum regulation with maximum pressure
controlled to a safe limit. When this is so, breastpumps are safe, easy to use,
and help mothers to breastfeed in cases when they would not ordinarily have been
able to do so. A mother should obtain her pump from a knowledgeable health care
provider who can give her the guidance necessary to use the pump safely. Do not
use a breast pump with the vacuum controlled by the mother pushing a button to
stop the vacuum. It is possible for the vacuum pressure to go too high before
the mother stops it. Injury to the breast tissue with these types of breastpumps
is common.
3. Is it okay to buy a pump from a company that also sells formula?
It is likely that a company selling formula, or formula feeding equipment, would
have a conflict of interest since breastfeeding decreases their profits. It is
more likely you will obtain a better breastpump from a company which does not
have a vested interest in formula sales.
4. Is it okay to buy a second-hand breastpump?
Breastpumps which are intended for personal use are single-user products. Use by
more than one person could be a health hazard if the person using it previously
carries a virus resistant to death by boiling, air exposure, or over time, i.e.
hepatitis C, as one example. Rental pumps are designed for multiple users and do
not constitute the same risk. Parts of the rental pump touching milk are
purchased by each individual mother. Carrying cases are of hard, non-porous
materials easily cleaned and disinfected. Personal breastpump cases are of soft
cloth materials which can not be disinfected. Don’t take a chance with your
baby’s health, or your own!
PUMPING TO REPLACE FEEDINGS
1. If I’m going out for an evening, or later, when I’m going back to work,
how much milk do I leave for the baby?
It is helpful to know the average amount of milk a baby drinks per feeding.
Remember, average means there is a normal range above and below that amount
for individual feeds and individual babies. On average, babies are drinking
approximately 480ml(16 oz) per 24 hours by the end of their first week of life.
This amount divided by the number of feeds/24 hours will give you the average
intake per feed. On average there would be eight nutritional feeds per day
plus comfort feeds to calm your baby or help your baby go to sleep. At every
growth spurt the daily intake goes up by approximately 120ml(4oz). There are
growth spurts at 10 days, 3 weeks, 6 weeks, and 3 months. Growth spurts also
occur approximately every 3 months after that but the increased intake is taken
over by the initiation of solids around 6 months and increased amounts of solids
at 9 and 12 months. After the 3 month growth spurt the baby is taking in an
average of 960ml(32oz)/24hours. This amount of milk stays relatively stable
until the baby is approximately 15 months and then gradually decreases as the
baby weans between two and four years of age. An average nutritional feed amount
chart would look like this:
10 days - 3 wks: 600ml(20oz)/24 hrs divided by 8 feeds/day =
75ml(2.5oz)/feed
3 weeks - 6 wks: 720ml(24oz)/24 hrs divided by 8 feeds/day =
90ml(3oz)/feed
6 wks - 3 mths: 840ml(28oz)/24 hrs divided by 7 feeds/day =
120ml(4oz)/feed
3 mths - 6 mths: 960ml(32oz)/24 hrs divided by 6 feeds/day =
120-180ml/feed
6 mths - 15 mths: 960ml(32oz)/24 hrs divided by 6 feeds/day plus
gradually increasing family foods.
15 mths to 2 years plus: feeds which gradually decrease according to
baby’s and mom’s weaning from feeds at breast and baby’s increased intake of
family foods and drinks.
Remember, this chart refers only to nutritional feeds. Baby also needs
comfort feeds which provide the non-nutritive suckling necessary to maintain
mom’s milk supply. Pacifier use interferes with non-nutritive suckling and may
lead to an insufficient milk supply. Before 6 months there should be no span
greater than 6 hours between feeds or pumps, and no less than 6
feeds/pumps in 24 hours in order for the mother to maintain sufficient milk
volumes.
2. How much milk should I have in the freezer before going back to work? How
do I get that amount into the freezer? Also, when should you be pumping this
milk? Does it matter if it is before, or after, a feeding?
It’s best to take only 30ml(1oz) of milk a day if you are storing milk away. If
you take more you are creating a milk supply greater than your baby needs in 24
hours. An oversupply of milk can result in milk stasis (stagnant pool of milk).
This can lead to blocked ducts and mastitis because the baby can’t consume all
the milk being produced. If you decide not to pump one day, 30ml(1oz) extra in a
day is unlikely to cause a problem. Also, your baby is not likely to miss 30ml
taken from his daily intake. The best time to pump is after a feed around
mid-day. Milk taken early in the day or at the beginning of a feed when the
breasts are very full is less creamy. If you only leave skim milk for your baby,
your baby and your caretaker will not be very happy. In the evening the milk is
much more creamy but this is because the volume is lower. Although it is very
calorie-rich and satisfying for the baby, it is difficult to obtain, especially
if your baby is cluster feeding. So around lunch time is the best time to save
your 30ml amount.
Pump the breast on which baby started the feed for approximately 10 minutes or
until you have obtained 30ml. If you do not obtain 30ml in 10 minutes, go to the
2nd breast and take what you need to make up the 30ml. Freeze the 1st day’s
pumped milk. Each day chill the newly pumped milk until it is cold before adding
to the frozen milk. Be careful not to add a greater quantity of fresh milk than
is already frozen as thawing could occur. Over a five day period you will have
saved one 150 ml container. For the 5 containers needed before starting back at
work you should pump 30ml per day for 25 days. If you do not have time for this,
pump after more feeds per day, but then you must be consistent in pumping every
day. You will increase your milk supply by doing this. If you miss a day you are
likely to develop a blocked duct.
Once you have saved up the amount needed for an average nutritional feed
according to your baby’s age, you can miss a feed at breast and give the baby
the pumped milk instead. But, you must then pump to remove an equivalent amount
of milk from your breasts. You need to have one average feed amount for each
feeding you will miss on your 1st day at work as well as a couple of emergency
feeds in case you are delayed occasionally. If you will miss 3 feeds and the
average feed amount for your baby’s age is 150ml(5oz), you should have five
150ml(5oz) containers of pumped milk saved for your first day back at work.
While at work that day, you will need to pump at your breaks and lunch, as able,
and bring home with you three 150ml containers of milk for the next day.
For stay-at-home moms who need to leave milk for their baby only occasionally,
you should save a container of milk as above. Whenever it is offered to baby you
should pump within an hour or two of the missed feeding time. Express the amount
of milk the baby drank. In this way your milk supply will be maintained
according to your baby’s needs. If the “freezer feeds your baby”, then you must
“feed the freezer”!
3. Is it ok to let my partner give the baby a bottle of expressed milk while
I catch up on my rest?
If you are feeling you are not able to continue breastfeeding because you are
too tired, then having dad give pumped milk is preferable to any other
alternative. However, you must remember that you need your baby to remove milk
from your breasts just as much as your baby needs the milk. For example, if you
know your baby will not want to feed until midnight but you really need to go to
bed around 2300, double pump for approximately 10 to 15 minutes. You will obtain
the amount of milk your baby would normally drink around that time. By 2330 you
are asleep. At midnight dad feeds the baby the pumped milk, burps, changes, and
rocks her to sleep. Your partner is asleep by 0120. You have had almost two
extra hours of sleep but you did not technically miss the midnight feeding. By
0300 your breasts are waking you up because they need the baby to empty them
again. If you had gone to bed after the 2100 feeding you probably would have
woken up at 0130 just as your baby and partner had gone to sleep because your
breasts were too full and uncomfortable. Then you would have had to pump at that
time. If not, you could develop blocked ducts and mastitis.
4. A lot of people say that if the father can’t give the baby a bottle, he
won’t bond with the baby. Is this true? Should I be pumping milk so he can feed
the baby too?
There are many ways a father can bond with his baby. He can bathe, diaper,
massage, burp, cuddle, soothe, play with, talk to, sing to, and carry in a baby
carrier or sling. Whenever a dad has face-to-face contact with his baby he is
making the kind of contact that creates a close bond with his child. Giving a
bottle is definitely not necessary.
5. If I’m away from the baby and she drinks a bottle of expressed milk, how
soon do I have to pump to replace that feeding? Does it matter if I pump an hour
or two later?
You should try and pump as soon as possible after the missed feeding because any
pressure build-up in your breasts can cause atrophy or shrivelling up of the
cells which produce milk. This leads to a loss of milk producing cells and can
lower your milk volume. Pressure in your breasts is not good for maintenance of
your milk supply.
6. How long should it take to pump enough milk to replace what the baby ate?
If she ate more than I can pump in 20 minutes, does that mean something is
wrong? What should I do?
If you have a double electric pump you should be able to pump what your baby
would normally have taken from the breast at that particular time in 10-15
minutes. If you are using a single manual or electric pump you will need to
switch back and forth between breasts following the milk flow, for approximately
20 to 30 minutes. If you are used to using the pump your milk ejection reflex
(let-down) will be a conditioned response. Your milk will let down more quickly
after you have used the pump a few times.
If your baby has been fussing at the breast at that time of day, seems not to be
getting enough milk at that particular feeding time, and would regularly drink
more than you can pump at that time, you may need to increase your milk supply
at that particular time of day.
PUMPING TO INCREASE MILK SUPPLY
1. If I have low milk supply, how do I use pumping to increase it?
The cells in the breasts which produce milk are always oozing. From one feeding
to the next a volume of milk builds up depending on the individual mother’s rate
of milk synthesis. The less milk left in a breast, the faster the rate of milk
synthesis. Most babies who are getting enough milk will leave residual milk in
the breast at each feeding. The rate of milk flow gradually decreases as the
volume of milk in the breast reduces. The baby becomes restless, sleepy, or
frustrated when the flow rate is too slow. It would be like you trying to drink
from a slowly dripping tap when you are very thirsty. You would rather find a
faster flowing tap.
By pumping with an efficient double electric pump after a feed, you can
“super-empty” the breasts and increase the rate of milk synthesis. Pumps do not
get sleepy or frustrated, do not use up extra calories when they keep pumping,
and do not need to gain weight. However, the residual milk removed by the pump
was intended to be part of the baby’s meal at the next feed. It must be given
back to the baby at the next feed. If you don’t the baby will be hungry after
that feed too.
If your baby is too full after the next feed at breast to take the residual milk
from the last pumping, do not pump. You have enough milk for your baby’s needs
at that time. However, as soon as your baby is acting hungry after a feed, give
the baby the pumped residual milk. Pump after that feeding to stimulate greater
milk production at that time. The baby determines the amount of post-feed
pumping you need to do. As the milk supply increases to meet the baby’s needs,
the baby will not need a supplement, and you will not need to pump.
2. I’m pumping after a feeding to increase supply but getting nothing. Does
this mean this is a waste of time?
Not at all. It means you have a very efficient baby who is doing a good job
taking out all available milk. But, the baby is still hungry enough to keep
feeding even when the flow rate is very low. When you are getting nothing, you
definitely need to be pumping to increase your milk production. If you are
pumping a lot of milk after feeds, it means either you don’t need to increase
your milk supply, or, you have a baby who is not effectively accessing your
milk.
3. I’m pumping to bring up milk supply, but my baby is ALWAYS hungry - she
feeds at the breast, I pump, she drinks what I pump, and I have to start over
again immediately because she is still crying and restless. Is this normal?
This is not normal. It means that the residual milk you have given to your baby
is not sufficient to meet her needs at this time. Until your milk supply is
sufficient for her needs you will have to add banked human milk or formula to
her diet. The only person who knows how much your baby needs to consume at an
individual feed is your baby. Every baby has the right to be full at a meal so
they can interact and play with family, and sleep soundly until it is time for
the next feed. If you need to give your baby formula, you should be pumping
after every feed at breast, even the ones when the baby has not wanted a
supplement, until there has been no need for any formula for at least 48 hours.
Then return to pumping only after feeds when the baby has required a pumped milk
supplement. If you need to use formula for more than a couple of days, contact
your physician for a prescription for domperidone per Dr. Newman’s protocol to
assist in augmentation of your milk supply. If your milk supply is significantly
lower than the expected volumes for your baby’s weight and age, you should also
ask your physician to check your thyroid function and your blood sugar levels.
If these are not normal they will interfere with your ability to produce milk.
4. I don’t have time to pump after every feeding. What should I do?
Enlist the help of relatives and friends to help you with increasing your milk
supply. Breastfeed your baby only as long as she is actively swallowing, then
switch to the opposite breast. As soon as your baby slows down on the second
breast, get your helper to feed the baby the supplement while you do your
post-feed pumping in the presence of your baby. This helps increase your
prolactin levels. If you do not have a helper you should consider a hands-free
pumping bra so you can hold your baby while you pump. If post-feed pumping is
happening for longer than a few days, you should consider giving the baby the
residual pumped milk at breast with a supplementing device. This eliminates the
need for a second feed for the baby, conserves time and energy for both mom and
baby, and gives the baby more positive reinforcement at breast.
For additional help look at Dr. Jane Morton's video on Maximizing Milk
Production at
http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
PUMPING BECAUSE YOU CAN’T FEED YOUR BABY YOURSELF
1. What if I’m sick or in too much pain to feed my baby myself right now? Is
there a way to use pumping to keep up my milk supply so I can still breastfeed
later? How?
You should do the best you can to maintain your milk supply by double pumping
with an automatic cycling electric breastpump for 15-20 minutes approximately
the same number of times a day as your baby is feeding. If possible, try to
follow your baby’s feeding schedule so you can return to feeding when able, and
your milk supply will be in synchrony with your baby’s needs. If your milk
supply does decrease during this time, you can increase it again by pumping once
you are better. Even adoptive mothers are able to develop milk supplies for
their babies by pumping.
2. Will my baby still be able to breastfeed after taking bottles? What kind
of bottles or feeding methods can we use with the expressed breast milk until I
can breastfeed again?
As long as there is a good milk supply available to the baby, most babies under
six weeks will go back to breast easily. Even after this period babies will
return to breast with assistance from a skilled Lactation Consultant. Cup
feeding may be tried so the baby does not develop nipple confusion. If you are
spilling a lot of milk or your helpers are not willing to cup feed, try to use a
bottle teat which will keep your baby maintaining a wide gape and rhythmical
jaw-swallow suckling rather than sucking. A special feeder called a Mini-Haberman
may be useful because it is interactive and does not flow unless the baby
actually works the jaw. Remember, the most important goal is to provide your
milk for your baby. Returning the baby to breast is a much easier task.
3. What if my baby can’t breastfeed right now because of surgery or
pre-maturity?
This baby needs your milk even more so. The most important gift you can give
your baby is your milk. If your baby is not able to feed from birth you should
start expressing your milk within 6 hours of birth. Double pump for 15-20
minutes at least 8 times in 24 hours with an automatic cycling electric pump.
Most babies feed 8 times a day at the beginning but not every 3 hours. A
suggested pumping pattern which is similar to a baby’s feeding pattern and still
allows you to get a little more rest would be as follows: 0100-long
sleep-0500-0700-0930-1230-afternoon nap-1630-1900-2200-0100-long sleep. You can
substitute any hour for the ones noted, or add or subtract a half hour or so
from each time as long as you keep to basically the same pattern and you fit in
8 pumps a day. Even though your baby may not be drinking very much of your milk,
your body needs to know that your baby is there. You need to develop the same
amount of milk as a mother with a full-term healthy baby. (See chart of average
amounts above.) Once your baby is better and able to feed at breast you will
need a good milk supply. This milk supply is much easier to develop and maintain
in the first days after the birth of your baby.
GENERAL PUMPING CONCERNS
1. I’m new to pumping and nothing is coming out. What is wrong with me?
If you pump at a time of day when your baby would not have been feeding
normally, you will not usually get much milk. Make sure you have an effective
pump which is comfortable to use. At first, try your pump when your breasts are
full and you are ready to feed. Only take a small amount of milk, i.e.
30ml(1oz). After you have used the pump several times, your brain will recognise
the pump. Your milk ejection reflex (let-down) will become a conditioned
response to the pump and will occur more quickly.
2. How high a vacuum pressure should I use on the electric pump? If I turn it
up higher will I get more milk?
You should use the pump at the pressure most comfortable for you. Increasing the
pressure can cause discomfort which may inhibit your let-down and actually
decrease the amount of milk you will obtain. High pressure may cause swelling of
the sensitive tissue in the areolar and nipple area and may decrease the flow of
milk. High pressure in a mom with low volume can cause the milk ducts to
collapse and decrease the flow of milk. If a mom has high volume and ducts which
are full of milk this does not happen. Moms with better volumes can use higher
pressures.
You should start the pump at a low pressure with more rapid cycling to initiate
a let-down. This mimics a baby who is doing eliciting let-down suckling with
gentle quick jaw motions. If let-down occurs change the pump to a slower,
stronger pressure which would be mimicking a baby doing rhythmical jaw-swallow
motions. For example, on a Medela Symphony pump, most moms start the pump at 3-4
droplets of pressure. When the pump automatically switches from stimulation
phase to expression phase the pressure increases to 6-8 bars of pressure on the
display, with the cycling automatically synchronised to the pressure. If
let-down occurs before the pump switches automatically, you can change the pump
earlier by pushing the let-down button.
3. Breastfeeding is going well. I don’t need to pump for my baby, but I would
like to leave her on occasion with her dad so I can go out. When should I start
pumping?
It’s best to wait until after the baby has been through the six week growth
spurt. There are many increases in the milk supply in the first six weeks which
the mom and baby go through together. The sucking reflex is still quite strong
around this age. Most babies will accept a bottle if they feel comfortable with
the person giving the bottle and that person is not anxious. Babies are body
language communicators and will perceive something is wrong if the adults around
them are anxious.
Around three months babies have a huge cognitive leap. Their brains increase
functioning from a mostly “primitive” level where instincts and reflexes are the
main governors of baby’s behaviour to the “new” brain or neo-cortex. Babies then
develop volitional control or “own free will”. Most babies at this time will
choose not to take a bottle if they have a choice. They will not starve
themselves. A hungry baby will eat. However, a well-fed baby can wait quite a
long time before they are truly hungry. This can be very distressing for
caregivers. If it is important for you to be able to leave your baby with
someone else who must be able to feed the baby, you should introduce the bottle
before three months. Be careful that bottles do not become more common than
feeding at breast. Babies, like all of us, are creatures of habit. They
generally will prefer what they are most used to.
4. I've gone back to work/school and my baby is hardly drinking anything from
a bottle while I'm gone. Should I pump every few hours, or just enough to match
what she drinks?
Many babies do not drink much the first 3 weeks after mom returns to work. They
seem to be waiting for mom to come, and restrict intake while they wait. Moms
think they don’t need to pump so much and often cut pumping times so milk supply
is reduced. Unfortunately, after approximately 3 weeks the baby has figured out
the new routine, settled in, and begins to drink the average amounts for age.
Mom no longer has sufficient milk volumes and must now try and increase milk
supply. Keep pumping as if your baby would drink the average amounts to maintain
your milk supply for at least the 1st month back at work. If your baby is still
not drinking much by then it is probably safe to reduce pumping to amount of
milk being consumed by baby when mom is away.
5. I had a regular pumping schedule at work and seemed to be pumping the same
amount my baby was drinking. Suddenly she is drinking a lot more than I'm
pumping. What should I do?
Try and pump 5 minutes longer at each pump session. By pumping
“non-productively: - with very little flow, you are stimulating greater
production. Within a few days you should notice an increased volume. If you are
able, you can also do a “growth spurt day” with the pump. Pump for 5 minutes
every hour for as many hours in a row as you can. You might be able to pump
every hour for 3 hours and then not for the next 3 hours, and then every hour
for the next 3 hours. By pumping this way you are mimicking a baby going through
a growth spurt. This often helps to increase milk supply very quickly.
6. After pumping to replace a feeding, my breasts never feel as empty as they
do after the baby has nursed. I can even feel a little pool of milk in one
breast that just doesn't want to let go! Is this normal?
Try massaging the breasts with the heels of your hand, your fingers, and thumbs
in the last 5 minutes of your pumping to bring all the milk forward so the pump
can access it. Many moms have areas of their breasts dependent on gravity where
milk pools. The pump may not be able to overcome the gravity and access that
milk. Lifting the dependent areas of your breast to help the milk flow usually
works. It's sort of like lifting a sagging taupaulin of water and letting it
flow out.
7. I have scar tissue on my nipples from damage at the beginning when my
latching technique was incorrect.. When I pump the tissue turns red/purple. Is
this anything to worry about?
This frequently happens with scar tissue on the nipples. It occurs in many
mothers and nothing seems to alleviate it. The mothers state that it is not
uncomfortable. Be careful that you do not increase the vacuum pressure of the
pump beyond comfort as it may damage sensitive tissue. Try pumping at the lowest
pressure that will stimulate let-down and allow milk to flow.
8. How do I know if I have the correct flange size for my breastshields?
Your nipples should be able to go in and out of the flange without rubbing
against the sides of the breastshield or being pinched. If there is any
discomfort, the breastshield cone should be changed for a larger size. Using a
safe lubricant can also reduce friction.
MILK STORAGE:
Please go to this web site for excellent information:
http://www.medela.com/NewFiles/faq/coll_store.html
Written November, 2005 by:
Joan M. Fisher, RN, BN, MEd, IBCLC
Lactation Consulting Services since1985
76 Leopolds Drive, Ottawa, K1V 7E3
613-736-1795, www.breastfeedinghelp.ca
May be copied and distributed without further permission.